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（由申请人提供）：根据美国癌症协会的说法，每年约有130万人被诊断出患有癌症，每年治疗癌症的成本超过6009亿美元。与癌症相关的心理健康和社会心理因素的认可和治疗不足。心理健康评估和肿瘤学动态转诊（MHADRO）使肿瘤学治疗提供者能够有效筛选和监视五个重要的患者护理领域，包括：（1）心理健康功能； （2）与癌症相关的身体症状/副作用； （3）患者支持者的合作伙伴关系； （4）治疗障碍； （5）遵守医疗方案和生活方式改变建议。 Mhadro的个性化摘要报告有助于肿瘤治疗提供者在存在临床心理健康症状时是否以及如何干预，或者当患者报告对治疗或支持的渴望时如何进行干预。选择动态推荐的患者摘要报告，释放信息的授权以及他们以电子方式传输给有资格的心理健康提供者的个人联系信息，后者随后负责与患者联系以讨论治疗方案。这个过程利用了安全的，符合HIPAA的透射技术。第2阶段的特定目的是：（1）根据第1阶段的结果进行设计改进； （2）测试改进的Mhadro，对30名参与肿瘤治疗中心的30名患者进行了现场试验； （3）评估Mhadro在1000名混合癌症患者的单个盲，随机对照试验中的有效性。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，无论小组分配如何，都将在基线和基线后2、4、6和12个月接受相同的评估程序。分配给干预小组的人将在五个评估中的每个评估中印刷其医疗保健提供者报告。这些报告将由其肿瘤治疗团队进行审查，并将针对遇难的患者制定治疗计划。该患者将收到一份患者的反馈报告，该报告将由受过训练的研究协调员（医疗保健专业人员）与他或她进行审查。在评估期间，将有机会获得有关可用的心理社会支持小组的更多信息，并向精神科医生，心理健康顾问和/或吸烟戒烟计划提供更多信息。分配给控制条件的受试者将接受相同的五次Mhadro评估。但是，他们的报告不会印刷，也不会提供他们的心理健康推荐或社会心理支持小组信息。相反，将使用现场提供的护理标准（即治疗态度）对其进行管理。我们将使用广义估计方程（GEE）和线性混合建模（LMM）来检查遇险的群体差异，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几个国家组织提倡常规筛查癌症患者的心理困扰，并强调建立协作性患者支持者伙伴关系以解决心理社会问题的核心作用。缺乏对社会心理因素和患者支持者伙伴关系的一致评估，这是一个重大的问题，即影响深远的后果，包括过度痛苦，生活质量受损，治疗不满和治疗不遵守。 Mhadro有可能通过识别患者来影响这些结果，帮助团队决定应采取什么行动，加强患者提供者的伙伴关系，生成个性化的患者反馈报告，促进心理健康治疗的参与以及监测患者对治疗的反应。

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