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

美国约有680，000名青少年和年轻成人癌症幸存者（AYACS），这个数字很可能 随着这个年龄段癌症发病率的上升，AYACS经历重大中断， 实现规范的发展里程碑（例如完成教育，发展职业生涯，约会， 婚姻，生育），这往往会导致抑郁症状的发病率高于健康同龄人 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相关， 对医疗建议的依从性降低，医疗保健利用/成本增加，死亡风险升高。 虽然对抑郁症的心理社会干预在一般人群中是有效的，但很少有人被 适用于AYACS。此外，改善抑郁症状的干预措施通常是 亲自提供，这导致了许多参与障碍（例如，距离，有限的临床医生 可用性“小时后”），这是有问题的AYACS谁往往有许多竞争的承诺， 学校，工作和为人父母因此，至关重要的是要制定针对青少年儿童的干预措施， 远程和按需交付，例如移动的健康应用程序（mHealth应用程序）。的目的 建议是准备和优化mHealth应用程序，以促进抑郁症状的自我管理， AYACS（iManageAYA），由多阶段优化策略（MOST）框架指导。最是一年 一个从工程学中改编而来的框架，它使用高效的析因实验来评估个体和 干预措施的综合效果，以确定哪些干预措施可以减少、消除或取代 以提高效率。在K99阶段，我建议使用迭代的以用户为中心的设计过程来准备 iManageAYA的原型是可用的，可接受的，AYACS可行的。本次干预将包括 一个核心应用程序和四个循证组件：1）行为激活; 2）认知重建; 3） 正念训练; 4）同伴支持。在R 00阶段，我将确定哪些干预组件 使用全析因实验减少抑郁症状。我将用这个实验的结果来开发 一种干预措施，只包括显著有助于减少抑郁症状的成分 在AYACS中，尽量减少参与者的负担。我计划提出未来的研究将测试这种功效 优化干预措施，以及传播和实施这些措施的战略。除了拟议的 研究，我将扩展我的知识和技能：1）以用户为中心的设计; 2）MOST方法; 3） 与AYACS进行临床试验; 4）传播和实施科学和5）专业 发展这个K99/R 00奖将使我过渡到一个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个独立的调查员。

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.