Development of an informatics pathway from screening to online services for depression in an oncology setting (iPath*D)

开发肿瘤学背景下抑郁症从筛查到在线服务的信息学途径 (iPath*D)

• 批准号: 10373454
• 负责人: PAUL JAMES BARR
• 金额: $ 24.26万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10373454
• 关键词: Address; Adherence; Affect; Belief; Cancer Center; Cancer Patient; Caring; Cellular Phone; Chemotherapy and/or radiation; Clinic; Clinic Visits; Cognitive Therapy; Communication; Computerized Cognitive Behavioral Therapy; Consolidated Framework for Implementation Research; Consultations; Data; Decision Aid; Depression screen; Detection; Development; Diagnosis; Disease remission; Enrollment; Ensure; Evaluation; Evidence based treatment; Future; General Population; Goals; Health; Health Services Accessibility; Healthcare; Individual; Informatics; Intervention; Interview; Knowledge; Location; Malignant Neoplasms; Measures; Medicare/Medicaid; Mental Depression; Mental Health; Mental disorders; Modeling; Norris Cotton Cancer Center; Oncology; Outcome; Pathway interactions; Patient Monitoring; Patient Preferences; Patients; Persons; Prevalence; Prevention; Protocols documentation; Psychiatrist; Quality of life; Questionnaires; Radiation therapy; Radiology Specialty; Recording of previous events; Recovery; Reporting; Research; Rural; Rural Community; Screening for cancer; Service delivery model; Services; Specialist; Suicide; System; Tablets; Testing; Time; Travel; Visit; acceptability and feasibility; arm; barrier to care; base; behavioral health; cancer care; cancer therapy; clinically significant; cost effectiveness; depressive symptoms; design; digital; future implementation; health care service utilization; health literacy; help-seeking behavior; improved; innovation; model design; model development; multi-site trial; novel; open label; patient portal; patient screening; physical conditioning; preference; prototype; response; rural setting; screening; simulation; software development; symptom treatment; symptomatic improvement; treatment adherence; treatment comparison; usability; user centered design; virtual

PROJECT SUMMARY Depression affects up to 20% of patients with cancer each year and despite the expansion of evidence-based treatments, most individuals do not receive treatment. Three key barriers to treatment exist: low detection, low mental health literacy (MHL) and limited treatment accessibility, exacerbated in rural settings. Innovative informatics solutions to barriers exist: automating screening, enhancing MHL through decision aids (DA) and increasing accessibility via location-independent, online evidence-based treatments, such as computerized cognitive behavioral therapy and virtual consultations. Yet there is a gap in identifying strategies to screen and connect individuals with unmet mental health needs in cancer settings to treatments. The objective for this R21 is to develop a novel online pathway to treatment (iPath*D) and establish its acceptability, usability and feasibility. iPath*D will be an online platform that connects patients screening positive for clinically significant depression in cancer settings to a range of online and in-person evidence-based treatments, facilitated by an interactive DA. iPath*D is designed to increase depression screening as well as knowledge about, and access to, evidence-based treatment in patients with cancer. iPath*D will be developed with patients and clinicians in a rural cancer center in VT where there is no universal depression screening and treatment options are limited. The specific aims are: Aim 1. Employ user-centered strategies to develop an online pathway from screening to treatment for depression in oncology; and Aim 2. Determine usability, acceptability and feasibility of implementing iPath*D in clinic and its preliminary impact on MHL, screening and treatment rates. The study tests the hypotheses that: (1) iPath*D will be acceptable and highly usable and will demonstrate preliminary impact of increased MHL, screening rates and treatment access. The development of the iPath*D follows a user centered design model. In Aim 1 patients from the cancer center with depression (n=15) will co-design iPath*D via participatory design activities to inform the design and functionality of iPath*D, and development of low and high-fidelity iPath*D prototypes, which will go through rounds of iterative development, with extensive usability evaluations, ensuring iPath*D surpasses usability metrics. In Aim 2, an open label, single arm pilot, with patients beginning treatment at the cancer center, scoring 10≤ PHQ-9 ≤27 (n=30), will receive iPath*D. Real world usability, acceptability and feasibility will be assessed, and preliminary data on MHL, rates of screening and treatment access, treatment initiation, adherence, QOL, and depression symptom improvement will be gathered. This research is innovative in developing and testing a novel services delivery model (iPath*D) that addresses existing barriers to care. The results are expected to have a major positive impact by providing proof-of-principle for the use of an online pathway to treatment with the potential for reaching an unprecedented number of individuals in rural cancer settings with unmet mental health needs.

项目摘要 抑郁症每年影响多达20％的癌症患者，并提出基于证据 治疗，大多数人没有接受治疗。存在三个关键治疗障碍：低检测，低 心理健康素养（MHL）和有限的治疗可及性，在粗糙的环境中加剧。创新的 存在有关障碍的信息解决方案：自动化筛查，通过决策AIDS（DA）增强MHL和 通过与位置独立的在线循证治疗（例如计算机化）来增加可访问性 认知行为疗法和虚拟咨询。然而，确定筛选策略和 将癌症环境中未满足心理健康需求的个人与治疗联系起来。 R21的目标 是开发一种新颖的在线治疗途径（IPath*d），并确定其可接受性，可用性和 可行性。 IPath*d将是一个在线平台，将筛查的患者连接起来，对临床意义上的筛查呈阳性 癌症环境中的抑郁症对一系列在线和面对面的循证疗法，由 互动DA。 IPath*d旨在增加抑郁症筛查以及有关和访问的知识 到癌症患者的循证治疗。 IPath*d将与患者和临床医生一起开发 VT的农村癌症中心没有普遍的抑郁症筛查和治疗选择有限。 具体目的是：AIM 1。采用以用户为中心的策略来开发从 筛查肿瘤学中的抑郁症；和目标2。确定可用性，可接受性和 在诊所实施IPath*d的可行性及其对MHL，筛查和的初步影响 治疗率。该研究检验了以下假设：（1）ipath*d可以接受，并且高度可用，并且会 展示了增加MHL，筛查率和治疗获取的初步影响。发展的发展 IPath*d遵循用户以用户为中心的设计模型。在癌症中心的AIM 1患者中 （n = 15）将通过参与设计活动共同设计IPath*d，以告知设计和功能 ipath*d，以及低收入和高保真ipath*d原型的发展，这将经历迭代的循环 开发，具有广泛的可用性评估，可确保IPath*D超过可用性指标。在AIM 2中 开放标签，单臂飞行员，患者在癌症中心开始治疗，得分为10≤PHQ-9≤27 （n = 30），将接收IPath*d。现实世界的可用性，可接受性和可行性将被评估和初步 有关MHL的数据，筛查和治疗访问率，治疗计划，依从性，生活质量和抑郁症 症状改善将被收集。这项研究在开发和测试新型服务方面具有创新 交付模型（IPath*d）解决了现有的护理障碍。结果预计将有一个专业 通过提供原理证明使用在线途径的潜在治疗方面的积极影响 在未满足心理健康需求的农村癌症环境中达到了前所未有的个体。