Technology Facilitated Behavioral Intervention for Depression among Diverse Patients in Ambulatory Oncology

摘要 抑郁症是癌症患者最常见的心理共病之一。肿瘤患者的抑郁症状升高是一个主要问题， 癌症患者的症状与健康相关的生活质量（HRQoL）差， 癌症治疗，延迟恢复工作和基线功能，更多的急诊室就诊， 自杀风险和更高的全因死亡率。治疗抑郁症的行为干预措施包括 有效，但这些循证干预措施在肿瘤学中的可扩展性和实施有限。 健康 解释 捕获 行为 人口。 信息技术（HIT）提供了一个理想的机会，加快管理，评分， 抑郁症筛查的有效性，简单和精确的测量工具， 可操作的数据，以筛选抑郁症，并提供务实和可扩展的循证 被证明可以减少抑郁症的干预措施， 尽管这些命中率的好处，使用基于技术的模型来筛选和提供 针对癌症抑郁症状的循证行为治疗仍然存在， 发展不足，执行不力。 我们 将 评估有效性和实施 以证据为基础的HIT行为治疗癌症患者的抑郁症状升高。这一击 治疗结合了系统的，电子健康记录整合的抑郁症状筛查， 个性化的HIT干预措施，以解决癌症患者中抑郁症治疗的差距。 这项研究是在两个大都市地区--芝加哥和迈阿密--的两个不同的卫生系统中进行的 （西北医学和迈阿密卫生系统大学）。我们的目标是进行务实的I型 我的癌症支持的有效性-实施混合试验-基于证据的定制行为HIT 治疗抑郁症升高的计划- 两大卫生系统。我们将建立我的癌症支持对抑郁症的有效性， 症状（即，主要结局）和焦虑、HRQoL和卫生服务使用（即次要结局） 与平时的护理相比。我们将评估“我的癌症支持”的实施过程及其对 患者和系统级结局，包括覆盖范围、采用、维护和可接受性。接下来我们就 确定促进者和障碍，以广泛实施我的癌症支持超越西北 医学和迈阿密大学卫生系统。最后，我们将探讨我的癌症的影响， 支持因社会经济地位、语言、疾病严重程度、抑郁症状严重程度、招募网站和 其他患者和临床特征。

Abstract Depressionis one of the most common psychological comorbidities experienced throughout the cancercontinuum. Elevated depressive symptoms in oncology patients is a major concern as unmanaged depressive symptoms in cancer patients is associated with poor health-related quality of life (HRQoL), poor adherence to cancer treatments, delayed return to work and baseline function, greater emergency department visits, greater risk of suicide, and higher all-cause mortality. Behavioral interventions for the management of depression are efficacious, but scalability and implementation of these evidence-based interventions in oncology is limited. Health interpretation capture behavioral populations. information technologies (HIT) provide an ideal opportunity t o expedite the administration, scoring, and of depression screening with well-validated, brief and precise measurement tools that can actionable data to screen for depression, and deliver pragmatic and scalable evidence-based interventions that are proven to reduce depressive symptomatology across various other Despite the benefits of these HITs,use of technology-based models to screen and deliver evidence-based behavioral treatments that address the depressive symptoms in cancer remains underdeveloped and poorly implemented. We will evaluate the effectiveness and the implementation of an evidence-based HIT behavioral treatment for cancer patients with elevated depressive symptoms. This HIT treatment combines systematic, electronic health record-integrated screening for depressive symptoms with an individually-tailored HIT interventions to address gaps in the treatment of depression among cancer patients. The study takes place across two distinct health systems in two major metropolitan areas—Chicago and Miami (Northwestern Medicine and University of Miami Health System). We aim to conduct a pragmatic Type I effectiveness-implementation hybrid trial of My Cancer Support—an evidence-based, tailored behavioral HIT program for the management of elevated depressive symptoms—in ambulatory oncology care settings within two large health systems. We will establish the effectiveness of My Cancer Support on depressive symptoms(i.e., primary outcome) and anxiety, HRQoL, and health services use (i.e. secondary outcomes) compared to usual care. We will evaluate the process of implementing My Cancer Support and its impact on patient and system-level outcomes, including reach, adoption, maintenance, and acceptability. Next, we will identify facilitators and barriers to wide-scale implementation of My Cancer Support beyond Northwestern Medicine and University of Miami Health System. Finally, we will explore whether the effects of My Cancer Support vary across SES, language, disease severity, severity of depressive symptoms, recruitment sites, and other patient and clinical characteristics.