Depression Screening & Treatment in Ovarian Cancer

简介(申请人提供)：艾琳·希恩博士在俄亥俄大学获得临床心理学博士学位，现为安德森癌症中心行为科学系博士后研究员。希恩博士将利用K07奖与一个由M.D.安德森医学和心理社会专家以及四位抑郁症和初级保健研究方面的全国专家(詹姆斯·科因博士、林恩·雷姆博士、约翰·威廉姆斯博士、詹姆斯·布雷博士)组成的指导团队进行培训。该项目采用纵向设计，嵌入可行性研究，以评估抑郁症的创新干预措施。修订后的前瞻性筛查计划已扩大到包括抑郁症的分级筛查战略，以及有关筛查时间、接受护理的质量和可能影响抑郁症的基本心理过程的额外问题。另一方面，试点干预的规模已经缩小，现在为患者提供了治疗选择，反映了管理型医疗环境中抑郁症治疗的现实。培训计划现在包括四位共同导师建议的正式课程和研讨会，以及每年前往宾夕法尼亚大学詹姆斯·科因博士的培训，并定期安排与林恩·雷姆博士和詹姆斯·布雷博士以及约翰·威廉姆斯博士的面对面会面。与指导团队的正式协议和具体角色已记录在案，并已提交。研究和培训计划将在M.D.安德森进行，该公司致力于研究和培训，有许多授课和合作的机会。安德森医学中心的妇科癌症中心每年治疗250-300名不同的卵巢癌患者。 抑郁症是癌症患者中最常见的精神障碍，严重影响患者的生活质量。然而，抑郁症在被发现时被低估了，也没有得到充分的治疗。该研究计划建议解决在繁忙的肿瘤学实践环境中阻碍检测和治疗严重抑郁症的许多障碍。筛查计划现在采用了一种简单的两阶段筛查方法，该方法可能比其他筛查工具显示出更好的阳性预测价值。试点干预将测试抑郁的卵巢癌患者的可行性和可接受性。它将通过电话和结构化认知行为疗法(CBT)杂志在患者家中交付。试点干预将持续3个月的10个疗程，涵盖一系列认知-行为技能。每项技能将建议一系列的应用选择，从副作用管理和减轻疼痛，到对功能丧失的担忧。雷姆博士和泰勒博士将在CBT管理部门共同监督希恩博士。这种干预是创新的，以前从未在任何癌症患者群体中进行过，包括卵巢癌患者。

DESCRIPTION (provided by applicant): Dr. Eileen Shinn earned her Ph.D. in Clinical Psychology from Ohio University and is a postdoctoral fellow in the Department of Behavioral Science at M.D. Anderson Cancer Center. Dr. Shinn will use the K07 award to train with a mentoring team comprised of medical and psychosocial experts at M. D. Anderson and four national experts in depression and primary care research (Drs. James Coyne, Lynn Rehm, John Williams, James Bray). This project has a longitudinal design with an embedded feasibility study to evaluate an innovative intervention for depression. The revised prospective screening plan has been expanded to include a hierarchical screening strategy for depression, as well as additional questions about timing of screening, quality of care received, and basic psychological processes which may affect depression. On the other hand, the pilot intervention has been scaled down and now offers patients a choice of treatment, reflecting the reality of depression treatment in managed-care settings. The training plan now includes formal coursework and workshops suggested by the 4 co-mentors, as well as annual training trips to Dr. James Coyne at U. Penn, and regularly scheduled face-to-face meetings with Drs. Lynn Rehm and James Bray, and to a lesser extent, Dr. John Williams. Formal agreements and specific roles with the mentoring team have been documented and are presented. The research and training plan will be conducted at M.D. Anderson, which has a commitment to research and training with numerous didactic and collaborative opportunities. The Gynecologic Cancer Center at M.D. Anderson treats 250-300 different ovarian cancer patients per year. Major depression is the most prevalent psychiatric disorder in cancer patients and severely disables patients' quality of life. Yet depression is underdiagnosed and inadequately treated when recognized. The research plan proposes to address many of the barriers that hinder the detection and treatment of major depression in busy oncology practice settings. The screening plan now features a brief 2-phase screening method which may demonstrate positive predictive value well above other screening instruments. The pilot intervention will test the feasibility and acceptability among depressed ovarian cancer patients. It will be delivered in the patient's home by telephone and a structured cognitive-behavioral therapy (CBT) journal. The pilot intervention will last 10 sessions over 3 months and cover a range of cognitive-behavioral skills. Each skill will suggest a choice of applications ranging from side-effect management and pain reduction, to concerns about losses in functioning. Drs. Rehm and Taylor will co-supervise Dr. Shinn in the CBT administration. This intervention is innovative and has not been done before with any group of cancer patients, including ovarian cancer patients.