Perioperative mental health intervention for older adults undergoing cancer surgery

接受癌症手术的老年人围术期心理健康干预

• 批准号: 10206501
• 负责人: Tanya M Wildes
• 金额: $ 24.58万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10206501
• 关键词: Acute; Address; Affect; Antidepressive Agents; Anxiety; Attention; Behavior Therapy; Behavioral; Benzodiazepines; Cessation of life; Climacteric; Clinical; Clinical Research; Clinical Trials Design; Communication; Community Practice; Coupled; Delirium; Depressed mood; Diagnosis; Effectiveness; Effectiveness of Interventions; Elderly; Emotional; Enrollment; Evidence based intervention; Family; Fright; Goals; Grant; Healthcare; Hospitals; Hybrids; Incidence; Individual; Institutes; Intervention; Malignant Neoplasms; Mental Depression; Mental Health; Mental disorders; Mission; Morbidity - disease rate; Motivation; Multicenter Trials; National Institute of Mental Health; Older Population; Operative Surgical Procedures; Outcome; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perioperative; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacology; Phase; Polypharmacy; Population; Postoperative Period; Preparation; Prevalence; Prevention; Procedures; Process; Protocols documentation; Provider; Psyche structure; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Research; Research Personnel; Risk; Surgical Oncology; Testing; Time; Walking; adverse outcome; anxiety symptoms; anxious; base; cancer care; cancer diagnosis; cancer surgery; clinical practice; clinically significant; compare effectiveness; depressive symptoms; dosage; effectiveness outcome; effectiveness testing; experience; falls; group intervention; hospital readmission; human old age (65+); implementation outcomes; improved; innovation; interactive feedback; medical complication; mortality; multidisciplinary; older patient; programs; protocol development; reduce symptoms; shared decision making; therapy development; time interval; treatment as usual; trial design

Abstract/Project Summary – PROJECT 2 Depression and anxiety are under-recognized and undertreated in older adults with cancer. More than a million older adults will be diagnosed with cancer this year. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with a life-changing diagnosis as well as functional and physical changes that accompany a major surgery. Most older adults with both cancer and depression/anxiety do not receive appropriate mental health treatment, and if they do, it is typically pharmacologic treatment only, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a tailored pharmacological and behavioral intervention bundle for older patients undergoing surgery for cancer, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing planned cancer surgery. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major surgery for cancer, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients with cancer undergoing oncologic surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults with cancer, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.

摘要/项目摘要 – 项目 2 超过一百万患有癌症的老年人的抑郁症和焦虑症未被充分认识和治疗。 今年，老年人将被诊断出患有癌症。 围手术期是一个特别脆弱的时期， 因为患者同时面临着改变生活的诊断以及功能和身体状况 大多数患有癌症和抑郁/焦虑的老年人不会出现伴随大手术的变化。 接受适当的心理健康治疗，如果这样做，通常只是药物治疗，进一步 加剧已经猖獗的多重用药。在这个提案中，我们将优化和测试定制的药物。 针对接受癌症手术的老年患者的药物和行为干预组合 临床上显着的抑郁和焦虑症状我们将进行围手术期心理保健。 干预组合包括：（1）应用行之有效的行为干预，即行为激活（BA）， 基于患者偏好和需求的策略；(2) 药物优化和取消处方 (MOD)， 旨在优化抗抑郁药物的剂量，并停止有害或无效的药物。 目标 1（适应）：通过协作规划方法，我们将适应、开发和实施 针对接受计划癌症手术的老年人的围手术期最佳心理健康干预组合。 通过利益相关者的意见，我们将开发并迭代调整行为和药物优化 在最初的方案制定之后，通过该人群实施干预捆绑。 治疗开发试验中，我们将通过互动反馈迭代优化干预措施 65 岁以上接受癌症大手术的患者和其他利益相关者，注意到障碍和 目标 2（测试）：使用混合 1 型随机对照试验设计， 我们将比较干预措施与常规护理在减轻症状方面的有效性 为了实现这一目标，研究人员对 100 名接受肿瘤手术的老年癌症患者进行了研究。 有抑郁和焦虑症状的患者将被随机分配到药物和行为组 干预束或常规护理与许多不良反应有关。 手术后的结果，包括医疗并发症、跌倒、谵妄和死亡率。 抑郁症行为激活治疗的干预组合中的优化和减少处方 预计不仅可以改善患有癌症的老年人的抑郁和焦虑症状 还有其他重要的术后结果。