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

项目总结/摘要 该项目的目的是改善癌症患者抑郁症的治疗。高达25%的 癌症患者会患上临床抑郁症，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下降有关， 大大增加了医疗费用。不幸的是，大约75%的癌症患者患有抑郁症， 农村地区的病人更不可能得到适当的治疗。 造成这种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， 治疗调整;（2）具有行为和心理健康经验的心理健康临床医生不足， 癌症患者的精神药理学治疗;（3）患者无法进行社会心理治疗 由于医疗疾病、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。 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持续改善 医疗条件。CoCM是一种以人群为基础的综合护理方法， 社会工作者、护士或心理学家等临床医生提供行为治疗，协调 心理社会护理，监测结果，并根据精神病顾问的意见调整治疗。虽然 CoCM模型在最近的荟萃分析中显示在癌症环境中非常有效， 高保真度的实施一直很缓慢，特别是在资源匮乏和农村地区。使用 该技术有可能增强CoCM在不同癌症环境中的实施和保真度。 这项拟议的研究将使用以人为本的设计方法来开发，构建和测试一个Web和移动的 平台，以加强在城市接受治疗的抑郁症患者的CoCM的实施和保真度 农村癌症中心。在研究的第一阶段，面向患者的网络和移动的应用程序以及面向临床医生的 网站的目标是：（1）加强患者和临床医生之间的治疗参与;（2）及时收集 病人报告的结果为基础的测量护理;（3）促进以病人为中心的共同决策 更好的治疗调整;（4）最大限度地遵守循证指南水平的行为 和药物治疗。在研究的第二阶段，技术增强型CoCM系统（t-CoCM）将 在实用的混合1型有效性实现中与通常的CoCM（u-CoCM）进行比较 随机对照试验，以评估他们实现CoCM和临床结局最佳保真度的能力。

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.