Using Technology to Optimize Collaborative Care Management of Depression in Urban and Rural Cancer Centers

项目摘要/摘要 该项目的目标是改善癌症患者抑郁的治疗。高达25%的 癌症患者临床上会变得抑郁，严重影响他们的生活质量和功能。 抑郁症与耐受和完成癌症治疗的能力降低有关，也与 显著增加了医疗成本。不幸的是，大约75%患有抑郁症的癌症患者并不是这样。 农村地区的患者得到适当治疗的可能性更小。 造成这一巨大治疗差距的原因包括：(1)缺乏心理社会随访的标准程序和 治疗调整；(2)没有足够的具有行为和治疗经验的心理健康临床医生 癌症患者的心理药理学治疗；(3)患者无法进行心理社会治疗 由于疾病、经济障碍、交通和其他后勤障碍；以及(4)持续的耻辱 以及缺乏与精神卫生保健相关的参与度。 协作护理管理(CoCM)是一种基于证据的护理系统，已被证明 导致癌症和其他疾病患者抑郁症状和生活质量的持续改善 医疗条件。CoCM是一种基于人群的综合护理方法，其中护理经理，他们是 临床医生，如社会工作者、护士或心理学家，提供行为治疗，协调 心理社会护理，监测结果，并在精神病学顾问的投入下调整治疗。虽然 最近的一项荟萃分析表明，CoCM模型在癌症环境中非常有效， 高保真技术的实施进展缓慢，特别是在资源匮乏的农村地区。对.的使用 技术有可能在不同的癌症环境中增强CoCM的实施和保真度。 这项拟议的研究将使用以人为中心的设计方法来开发、构建和测试网络和移动设备 为在城市接受治疗的抑郁症患者加强CoCM的实施和保真度的平台 以及乡村癌症中心。在研究的第一阶段，面向患者的Web和移动应用程序以及面向临床医生的 网站将旨在：(1)提高患者和临床医生之间的治疗参与度；(2)及时收集 患者报告的基于测量的护理结果；(3)促进以患者为中心的共享决策 用于更好的治疗调整；以及(4)最大限度地遵守循证指南水平的行为 以及药物治疗。在研究的第二阶段，技术增强型CoCM系统(t-CoCM)将 与通常的CoCM(u-CoCM)在实用的混合类型1有效性实现中的比较 随机对照试验，以评估他们实现CoCM最佳保真度和临床结果的能力。

Project Summary/Abstract The objective of this project is to improve the treatment of depression in cancer patients. Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life and functioning. Depression has been associated with a decreased ability to tolerate and complete cancer treatment, as well as significantly increased healthcare costs. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and patients in rural settings are even less likely to receive adequate treatment. Reasons for this large treatment gap include: (1) lack of standard processes for psychosocial follow-up and treatment adjustments; (2) inadequate availability of mental health clinicians with experience in behavioral and psychopharmacologic treatment of cancer patients; (3) patient inability to follow up with psychosocial treatment due to medical illness, financial barriers, and transportation and other logistical barriers; and (4) ongoing stigma and lack of engagement related to mental health care. Collaborative Care Management (CoCM) is an evidence-based system of care that has been shown to lead to sustained improvement in depression symptoms and quality of life in patients with cancer and other medical conditions. CoCM is a population-based, integrated care approach, where care managers, who are clinicians such as social workers, nurses or psychologists, deliver behavioral treatments, coordinate psychosocial care, monitor outcomes, and adjust treatment with the input of a psychiatric consultant. Although the CoCM model has been shown in a recent meta-analysis to be highly effective in the cancer setting, high-fidelity implementation has been slow, particularly in low-resourced and rural areas. The use of technology has the potential to enhance implementation and fidelity of CoCM in diverse cancer settings. This proposed study will use a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of CoCM of depression for patients being treated at urban and rural cancer centers. In Phase I of the study, patient-facing web and mobile applications and a clinician-facing website will aim to: (1) enhance treatment engagement among patients and clinicians; (2) collect timely patient-reported outcomes for measurement-based care; (3) promote patient-centered shared decision-making for better treatment adjustments; and (4) maximize adherence to evidence-based guideline-level behavioral and pharmacologic treatments. In Phase II of the study, the technology-enhanced CoCM system (t-CoCM) will be compared to usual CoCM (u-CoCM) in a pragmatic Hybrid Type 1 effectiveness-implementation randomized controlled trial to evaluate their ability to achieve optimal fidelity of CoCM and clinical outcomes.