Multifaceted Oncology Depression Program for Latinos

针对拉丁裔的多方面肿瘤抑郁症计划

• 批准号: 6712397
• 负责人: KATHLEEN R ELL
• 金额: $ 66.31万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-29 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6712397
• 关键词: Hispanic Americans; antidepressants; behavioral /social science research tag; clinical depression; clinical research; clinical trials; culture; human subject; human therapy evaluation; low socioeconomic status; major depression; medically underserved population; neoplasm /cancer; neoplasm /cancer therapy; oncology; patient oriented research; psychological aspect of cancer; psychotherapy; quality of life; therapy compliance

DESCRIPTION (provided by applicant): Patients with cancer are likely to experience clinically significant depressive symptoms, with depression negatively affecting quality of life, treatment adherence, and satisfaction with care. Low-income Hispanics are less likely to receive care for depression, but benefit with culturally appropriate care enhancements. A randomized clinical trial is proposed to test the effectiveness of a quality improvement intervention Multifaceted Oncology Depression Program (MODP) on depressive symptoms, functional status and quality of life, patient adherence to cancer treatment, and satisfaction with depression and cancer care among low-income predominantly Latino adults with cancer. Aimed at enhancing oncology care, MODP is designed to be integrated within public sector oncology care and is socio-culturally tailored. MODP includes an initial choice of antidepressant medications or structured Problem Solving Treatment (PST), patient/family depression education, depression treatment maintenance and relapse prevention counseling, depression care management based on a stepped care depression treatment algorithm; extension of the oncology care team with a Cancer Depression Clinical Specialist (CDCS), a case manager (CM) to provide health and systems navigation; a psychiatric consultant to provide supervision of the CDCS and consultation to oncologists; treatment adherence and outcome monitoring; and oncologist education on depression management. Cultural competency enhancements include: patient choice of first line treatment (med/PST) and degree of family participation in their depression care; PST tailored for Hispanic patients with cancer; bilingual, bicultural CM, CDCS; Spanish educational materials. Usual Care (UC) patients will receive the care and clinic services routinely provided to all patients with cancer plus an educational pamphlet (on depression and cancer, depression treatment, talking with your doctor about your depression, and community mental health care resources). With patient consent, the oncologist will be informed if UC patients screen positive for depression. The study will be conducted in a large public urban medical center oncology clinics serving low income, predominantly Latino patients. Following a depression screen, 350 adult patients with cancer who meet diagnostic criteria for major depression or dysthymia will be recruited and randomized to MODP or UC. Specific study outcomes will be examined at 6,12, and 18 months. The nature of relationships between socio-cultural and clinical factors and depression treatment adherence and outcomes care will be examined. A cost analysis will be conducted. Study Hypotheses: a) MODP will result in greater reduction of depressive symptoms (by increasing receipt of and adherence to appropriate depression treatment); b) in significant improvement in functional status, quality of life, and depression and cancer treatment adherence; and c) and satisfaction with care vs. UC. Secondary questions include what is the effect of MODP on symptoms such as pain and fatigue and functional impairment from these symptoms.

描述（由申请人提供）：癌症患者可能会出现临床上明显的抑郁症状，抑郁症会对生活质量，治疗依从性和对护理满意的影响产生负面影响。低收入的西班牙裔人不太可能接受抑郁症的护理，但在文化上适当的护理方面受益。提出了一项随机临床试验，以测试质量改善干预措施多面肿瘤学抑郁症计划（MODP）对抑郁症状，功能状况和生活质量，患者对癌症治疗的依从性以及对低收入抑郁症和癌症护理的满意度，低收入的主要拉丁裔成年人患有癌症。旨在增强肿瘤学护理，MODP旨在将其整合到公共部门的肿瘤学护理中，并根据社会文化量身定制。 MODP包括最初选择抗抑郁药或结构化问题治疗（PST），患者/家庭抑郁症教育，抑郁症治疗和预防复发咨询，基于阶梯护理抑郁症治疗算法的抑郁症护理管理；与癌症抑郁症临床专家（CDC）（CM）一起扩展肿瘤学护理团队（CM），以提供健康和系统导航；精神病顾问，向肿瘤学家提供疾病预防控制中心的监督和咨询；治疗依从性和结果监测；以及抑郁管理的肿瘤科医生教育。文化能力的提高包括：患者选择第一线治疗（MED/PST）以及家庭参与抑郁症护理的程度； PST为西班牙裔癌症患者量身定制；双语，双文化CM，CDC；西班牙教育材料。常规护理（UC）患者将通常提供给所有癌症患者以及教育小册子（关于抑郁和癌症，抑郁症治疗，与医生谈论您的抑郁症以及社区心理保健资源）的护理和诊所服务。在患者同意下，如果UC患者筛查抑郁症呈阳性，则将告知肿瘤科医生。该研究将在一个大型公共城市医学中心肿瘤学诊所进行，该诊所为低收入，主要是拉丁裔患者。抑郁症筛查后，将招募350例符合严重抑郁症或心律失常的诊断标准的癌症患者，并随机分配给MODP或UC。具体的研究结果将在6,12和18个月时检查。将检查社会文化和临床因素与抑郁治疗依从性和结果护理之间关系的性质。将进行成本分析。研究假设：a）MODP将导致抑郁症状的降低（通过增加并遵守适当的抑郁症治疗）； b）功能状况，生活质量以及抑郁和癌症治疗依从性的显着改善； c）和对Care vs. UC的满意。次要问题包括MODP对这些症状症状等症状的影响。