iManageAYA: Preparation and Optimization of a mHealth Intervention for Managing Depressive Symptoms in Adolescent and Young adult Cancer Survivors

在美国，大约有68万青少年和青年癌症幸存者(AYAC)，这个数字很可能 随着这一年龄段癌症发病率的上升，这一数字将会增长。AYACS经历了严重的中断 实现规范的发展里程碑(例如，完成教育、发展事业、约会、 结婚、生孩子)，与健康的同龄人相比，这往往会导致抑郁症状的发生率上升 和其他癌症幸存者。在癌症幸存者中，抑郁症状与较差的生活质量有关， 对医疗建议的遵从性降低，医疗保健利用率/成本增加，死亡风险上升。 虽然心理社会干预对抑郁症在普通人群中是有效的，但很少有人有效。 改装为与AYACS一起使用。此外，改善抑郁症状的干预措施通常是 面对面提供，这导致了许多参与障碍(例如，距离、有限的临床医生 可获得性)，这对AYAC来说是个问题，他们往往有许多相互竞争的承诺 作为学校、工作和育儿。因此，开发针对AYACS的干预措施至关重要，这种干预措施可以 远程和按需交付，例如移动健康应用程序(mHealth应用程序)。这样做的目的是 建议是准备和优化一款mHealth应用程序，以促进抑郁症状的自我管理 多阶段优化策略(MOST)框架指导下的AYACS(IManageAYA)。MOST是一个 改编自工程学的框架，使用高效的析因实验来评估个体和 综合干预组件的影响，以确定哪些组件可以减少、消除或替换 提高效率。在K99阶段，我建议使用迭代的以用户为中心的设计流程来准备 对AYACS可用、可接受且可行的iManageAYA原型。这一干预将包括 核心应用程序和四个基于证据的组件：1)行为激活；2)认知重构；3) 正念训练；4)同伴支持。在R00阶段，我将确定哪些干预组件 使用完整的析因实验减少抑郁症状。我将利用这个实验的结果来开发 只包括显著减轻抑郁症状的成分的干预措施 在AYAC中，将参与者的负担降至最低。我计划提出未来的研究将测试这种方法的效果 优化干预措施，以及传播和实施的战略。除了建议的 研究，我将在以下方面扩展我的知识和技能：1)以用户为中心的设计；2)最接近的方法；3) 与AYACS进行临床试验；4)传播和实施科学；5)专业 发展。这个K99/R00奖项将使我能够过渡到独立的职业生涯，进行创新 研究开发、评估、实施和传播心理社会干预措施，以解决独特的 AYACS的需求。我的指导团队和合作者拥有必要的技能和资源来帮助我 实现我的目标，并将确保我成功地过渡到一名独立的调查人员。

There are ~680,000 adolescent and young adult cancer survivors (AYACS) in the U.S., and this number is likely to grow as the incidence of cancer in this age-group is rising. AYACS experience significant disruptions to achieving normative developmental milestones (e.g. completion of education, developing a career, dating, marriage, child birth), which often results in elevated rates of depressive symptoms compared to healthy peers and other cancer survivors. Among cancer survivors, depressive symptoms associated with poorer quality of life, lower adherence to medical recommendations, increased healthcare utilization/costs, and elevated mortality risk. Though psychosocial interventions for depression are efficacious in the general population, few have been adapted for use with AYACS. Additionally, interventions to improve depressive symptoms have typically been provided in-person, which has resulted in many barriers to participation (e.g., distance, limited clinician availability “after hours”) that are problematic for AYACS who tend to have many competing commitments wuch as school, work, and parenting. Therefore, it is critical to develop AYACS-targeted interventions that can be delivered remotely and on-demand such as mobile health applications (mHealth apps). The objective of this proposal is to prepare and optimize a mHealth app to promote self-management of depressive symptoms among AYACS (iManageAYA), guided by the Multiphase Optimization Strategy (MOST) framework. MOST is a framework adapted from engineering that uses highly efficient factorial experiments to evaluate individual and combined effects of intervention components to determine which ones can be reduced, eliminated, or replaced to improve efficiency. During the K99 phase, I propose using an iterative user-centered design process to prepare a prototype of iManageAYA that is usable, acceptable, and feasible for AYACS. This intervention will consist of a core application and four evidence-based components: 1) behavioral activation; 2) cognitive restructuring; 3) mindfulness training; and 4) peer support. During the R00 phase, I will determine which intervention components reduce depressive symptoms using a full factorial experiment. I will use the results of this experiment to develop an intervention that only includes components that significantly contributed to reductions in depressive symptoms among AYACS, minimizing participant burden. I plan to propose future studies will test the efficacy of this optimized intervention, as well as strategies for its dissemination and implementation. In addition to the proposed research, I will extend my knowledge and skills in: 1) user-centered design; 2) the MOST approach; 3) the conduct of clinical trials with AYACS; 4) dissemination and implementation science and 5) professional development. This K99/R00 award will enable my transition to an independent career conducting innovative research to develop, evaluate, implement, and disseminate psychosocial interventions that address the unique needs of AYACS. My mentoring team and collaborators have the necessary skills and resources to assist me in achieving my goals and will ensure that I successfully transition to an independent investigator.