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

摘要 抑郁症是在整个癌症过程中经历的最常见的心理并发症之一。肿瘤科患者的抑郁症状升高是一个主要的担忧，因为它是一种失控的抑郁 癌症患者的症状与较低的健康相关生活质量(HRQOL)、较差的对 癌症治疗，延迟返回工作岗位和基线功能，更多的急诊科就诊，更多 自杀风险和更高的全因死亡率。管理抑郁症的行为干预措施有 在肿瘤学中，这些循证干预措施是有效的，但可扩展性和实施是有限的。 健康状况 释义 捕获 行为 人口。 信息技术(HIT)提供了一个理想的机会来加快管理、评分和 使用经过充分验证的、简单而精确的测量工具进行抑郁症筛查，这些工具可以 可操作的数据，用于筛查抑郁症，并提供务实和可扩展的循证证据 经证实可减少各种其他疾病的抑郁症状的干预措施 尽管有这些成功的好处，但使用基于技术的模型来筛选和交付 针对癌症抑郁症状的循证行为治疗仍然存在 欠发达，执行不力。 我们 将要 评估AWS的有效性和实施情况 抑郁症状升高的癌症患者的循证HIT行为治疗。这一击 治疗将系统的、电子健康记录集成的抑郁症状筛查与 个人化的HIT干预措施，以解决癌症患者抑郁治疗方面的差距。 这项研究在芝加哥和迈阿密两个主要大都市地区的两个不同的医疗系统中进行 (西北医学和迈阿密大学卫生系统)。我们的目标是进行一次务实的第一类 我的癌症支持的有效性-实施混合试验--一种基于证据的、量身定做的行为打击 管理抑郁症状升高的方案--在以下地区的门诊肿瘤护理环境中 两个大型医疗系统。我们将确定我的癌症支持对抑郁症的有效性 症状(即主要结果)和焦虑、HRQOL和医疗服务使用(即次要结果) 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以下方面的影响 患者和系统级别的结果，包括覆盖范围、采用、维护和可接受性。接下来，我们将 确定推动我的癌症支持在西北大学以外广泛实施的促进者和障碍 医学和迈阿密大学卫生系统。最后，我们将探索我的癌症是否会产生影响 支持因SES、语言、疾病严重程度、抑郁症状严重程度、招聘网站和 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.