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: 10544778
• 负责人: PAUL JAMES BARR
• 金额: $ 18.43万
• 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 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10544778
• 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; Cost Analysis; Data; Decision Aid; Depression screen; Detection; Development; Diagnosis; Disease remission; Educational process of instructing; Electronics; Ensure; Evaluation; Evidence based treatment; Future; General Population; Goals; Health; Health Expenditures; Health Services Accessibility; 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; Recommendation; 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; 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; multi-site trial; novel; open label; participant enrollment; patient portal; patient screening; physical conditioning; preference; prototype; response; rural setting; screening; simulation; software development; 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.

项目概要 尽管基于证据的研究不断扩大，但每年仍有高达 20% 的癌症患者受到抑郁症的影响 治疗，大多数人没有接受治疗，存在三个关键障碍：低检出率、低水平。 心理健康素养（MHL）和治疗可及性有限，在农村环境中加剧。 针对现有障碍的信息学解决方案：自动化筛选、通过决策辅助 (DA) 增强 MHL 以及 通过与位置无关的在线循证治疗（例如计算机化治疗）提高可及性 然而，在确定筛查和虚拟咨询策略方面存在差距。 将癌症环境中心理健康需求未得到满足的个人与治疗联系起来。 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 iPath*D 将成为一个在线平台，将筛选出具有临床意义的阳性患者连接起来。 癌症环境中的抑郁症到一系列在线和面对面的循证治疗，由 交互式 DA。 iPath*D 旨在增加筛查抑郁症以及相关知识和获取途径。 iPath*D 将与患者和叛逆者共同开发基于证据的癌症治疗方法。 佛蒙特州农村地区的癌症中心没有普遍的抑郁症筛查，治疗选择也很有限。 具体目标是： 目标 1. 采用以用户为中心的策略，开发一条在线途径 肿瘤学中抑郁症的筛查和治疗；以及 目标 2. 确定可用性、可接受性和 iPath*D在临床实施的可行性及其对MHL、筛查和治疗的初步影响 该研究测试了以下假设：(1) iPath*D 是可以接受的、高度可用的，并且会。 证明增加 MHL、筛查率和治疗机会的初步影响。 iPath*D 遵循以用户为中心的设计模型，针对癌症中心的 1 名抑郁症患者。 (n=15) 将通过参与式设计活动共同设计 iPath*D，以告知其设计和功能 iPath*D，以及低保真度和高保真度 iPath*D 原型的开发，这将经历多轮迭代 开发，并进行广泛的可用性评估，确保 iPath*D 超越目标 2 的可用性指标。 开放标签、单臂试点，患者在癌症中心开始治疗，评分 10≤ PHQ-9 ≤27 (n=30)，将获得 iPath*D，将评估现实世界的可用性、可接受性和可行性。 有关 MHL、筛查和治疗获得率、治疗开始、依从性、生活质量和抑郁症的数据 这项研究在开发和测试新型服务方面具有创新性。 解决现有护理障碍的交付模式 (iPath*D) 预计结果将产生重大影响。 通过为使用在线治疗途径提供潜在的原理验证来产生积极影响 帮助农村癌症地区数量空前、心理健康需求未得到满足的患者。