Mental Health Assessment and Dynamic Referral for Oncology (MHADRO)

心理健康评估和肿瘤学动态转诊 (MHADRO)

• 批准号: 8099433
• 负责人: Edwin D Boudreaux
• 金额: $ 49.3万
• 依托单位: POLARIS HEALTH DIRECTIONS, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-20 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8099433
• 关键词: Address; Adherence; Adverse effects; Advocate; Albert Einstein Cancer Center; American Cancer Society; Authorization documentation; Businesses; California; Cancer Center; Cancer Patient; Client; Clinical; Communities; Comprehensive Cancer Center; Comprehensive Health Care; Computer software; Confounding Factors (Epidemiology); Control Groups; Data; Development; Diagnosis; Distress; Economics; Effectiveness; Electronic Health Record; Equation; Evaluation; Feedback; Foundations; Fox Chase Cancer Center; Generations; Health; Health Insurance Portability and Accountability Act; Health Personnel; Health Professional; Health system; Hospitals; Institute of Medicine (U.S.); Institutes; Joints; Laboratories; Letters; Life Style; Logistics; Malignant Neoplasms; Medical; Mental Health; Modeling; Monitor; National Cancer Institute; National Comprehensive Cancer Network; Outcome; Pain; Patient Care; Patient Monitoring; Patients; Pennsylvania; Pharmaceutical Preparations; Phase; Printing; Procedures; Process; Professional counselor; Provider; Psychiatrist; Psychosocial Assessment and Care; Psychosocial Factor; Psychosocial Influences; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Regimen; Registries; Reporting; Research Institute; Research Training; Role; Schedule; Screening procedure; Secure; Severity of illness; Site; Small Business Technology Transfer Research; Summary Reports; Support Groups; Symptoms; System; Technology; Telefacsimile; Test Result; Testing; Time; Update; Wood material; Work; base; blind; cancer therapy; commercialization; cost; design; efficacy trial; group intervention; improved; indexing; interest; medical schools; mental health counseling; oncology; programs; psychological distress; response; smoking cessation; standard of care; stem; treatment as usual; treatment center; treatment planning; treatment response

DESCRIPTION (provided by applicant): According to the American Cancer Society, approximately 1.3 million people are diagnosed with cancer each year, with the annual cost of treating cancer exceeding $60.9 billion. Mental health and psychosocial factors associated with cancer are poorly recognized and under-treated. The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) enables oncology treatment providers to efficiently screen for and monitor five important patient care domains, including: (1) mental health functioning; (2) cancer-related physical symptoms/side effects; (3) the patient-provider partnership; (4) barriers to treatment; and (5) adherence with medical regimen and lifestyle change recommendations. The MHADRO's individualized summary reports help oncology treatment providers to decide whether and how to intervene when clinically elevated mental health symptoms are present or when a patient reports a desire for treatment or support. Patients who choose the dynamic referral have their summary report, an authorization to release information, and their personal contact information electronically transmitted to a credentialed mental health provider, who is then responsible for contacting the patient to discuss treatment options. This process utilizes secure, HIPAA-compliant transmittal technologies. Phase 2 specific aims are: (1) Make design improvements based on Phase 1 results; (2) Test the improved MHADRO with a field trial of 30 patients selected from three participating oncology treatment centers; and (3) Evaluate the effectiveness of the MHADRO during a single blind, randomized controlled trial of 1,000 mixed cancer patients. Patients will be randomly assigned to the Intervention Group (n=500) or the Control Group (n=500). All subjects, regardless of group assignment, will undergo the same assessment procedures at baseline and at 2, 4, 6, and 12 months post-baseline. Those assigned to the Intervention Group will have their Healthcare Provider Reports printed at each of the five assessments. These reports will be reviewed by their oncology treatment team and a treatment plan will be developed for distressed patients. The patient will receive a Patient Feedback Report, which will be reviewed with him or her by a trained research coordinator (a healthcare professional). During the assessment, the Intervention Group subjects will be given the opportunity to obtain more information on available psychosocial support groups and offered a dynamic referral to a psychiatrist, mental health counselor, and/or smoking cessation program. Subjects assigned to the Control Condition will undergo the same five MHADRO assessments. However, their reports will not be printed, nor will they be offered the mental health referrals or psychosocial support group information. Rather, they will be managed using the standard of care provided at the site (i.e., treatment-as-usual). We will use Generalized Estimating Equations (GEE) and Linear Mixed Modeling (LMM) to examine group differences in distress over time, while adjusting for potential confounding variables such as illness severity and phase of treatment. PUBLIC HEALTH RELEVANCE: Several national organizations, including the National Comprehensive Care Network, the National Cancer Institute, and the Institute of Medicine, have advocated routine screening for psychological distress among cancer patients and have emphasized the central role of building a collaborative patient-provider partnership to address psychosocial issues. The lack of consistent assessment of psychosocial factors and the patient-provider partnership is a significant problem with far-reaching consequences, including excess suffering, impaired quality of life, treatment dissatisfaction, and treatment non-adherence. The MHADRO has the potential to impact these outcomes through identifying distressed patients, helping the team decide what action should be taken, strengthening the patient-provider partnership, producing a personalized patient feedback report, facilitating mental health treatment engagement, and monitoring patients' response to treatment.

描述（申请人提供）：根据美国癌症协会的统计，每年约有 130 万人被诊断患有癌症，每年治疗癌症的费用超过 609 亿美元。与癌症相关的心理健康和心理社会因素尚未得到充分认识和治疗。肿瘤学心理健康评估和动态转诊 (MHADRO) 使肿瘤治疗提供者能够有效筛查和监测五个重要的患者护理领域，包括：(1) 心理健康功能； (2) 癌症相关的身体症状/副作用； (3) 医患伙伴关系； (4)治疗障碍； (5) 遵守医疗方案和改变生活方式的建议。 MHADRO 的个性化总结报告可帮助肿瘤治疗提供者决定当出现临床上升高的心理健康症状或当患者报告需要治疗或支持时是否以及如何进行干预。选择动态转诊的患者的总结报告、发布信息的授权以及他们的个人联系信息都会以电子方式传输给有资格的心理健康提供者，然后由该提供者负责联系患者讨论治疗方案。该过程利用安全、符合 HIPAA 的传输技术。第二阶段的具体目标是：（1）根据第一阶段的结果进行设计改进； (2) 通过从三个参与的肿瘤治疗中心选出的 30 名患者进行现场试验来测试改进的 MHADRO； (3) 在一项对 1,000 名混合癌症患者进行的单盲、随机对照试验中评估 MHADRO 的有效性。患者将被随机分配到干预组 (n=500) 或对照组 (n=500)。所有受试者，无论分组如何，都将在基线时以及基线后 2、4、6 和 12 个月接受相同的评估程序。分配到干预小组的人员将在五次评估中的每一次评估中打印他们的医疗保健提供者报告。这些报告将由他们的肿瘤治疗团队审查，并为痛苦的患者制定治疗计划。患者将收到一份患者反馈报告，该报告将由经过培训的研究协调员（医疗保健专业人员）与患者一起审查。在评估过程中，干预组受试者将有机会获得有关可用心理社会支持小组的更多信息，并动态转介给精神病医生、心理健康顾问和/或戒烟计划。分配到控制条件的受试者将接受相同的五次 MHADRO 评估。然而，他们的报告不会被打印，也不会向他们提供心理健康转介或心理社会支持小组信息。相反，他们将使用现场提供的护理标准进行管理（即照常治疗）。我们将使用广义估计方程 (GEE) 和线性混合模型 (LMM) 来检查随时间变化的痛苦的群体差异，同时调整潜在的混杂变量，例如疾病严重程度和治疗阶段。公共卫生相关性：包括国家综合护理网络、国家癌症研究所和医学研究所在内的多个国家组织提倡对癌症患者进行常规心理困扰筛查，并强调建立患者与提供者合作伙伴关系的核心作用来解决社会心理问题。缺乏对心理社会因素和患者与提供者伙伴关系的一致评估是一个重大问题，具有深远的后果，包括过度痛苦、生活质量受损、治疗不满意和不依从治疗。 MHADRO 有可能通过识别陷入困境的患者、帮助团队决定应采取哪些行动、加强患者与提供者的伙伴关系、生成个性化的患者反馈报告、促进心理健康治疗参与以及监测患者的反应来影响这些结果。治疗。

项目成果

Randomized controlled trial to test a computerized psychosocial cancer assessment and referral program: methods and research design.

测试计算机化社会心理癌症评估和转诊计划的随机对照试验：方法和研究设计。

• DOI: 10.1016/j.cct.2013.02.001
• 发表时间: 2013
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: O'Hea,ErinL;Cutillo,Alexandra;Dietzen,Laura;Harralson,Tina;Grissom,Grant;Person,Sharina;Boudreaux,EdwinD
• 通讯作者: Boudreaux,EdwinD