The following description was taken from the R01 version of this FOA.
The purpose of this Funding Opportunity Announcement (FOA) is to: identify new, information technology (IT)-enabled delivery models that support systematic screening and treatment of depression in cancer patients; test the feasibility of implementing these new delivery models in a variety of oncology practice settings, especially those serving under-served populations; test the effectiveness of these new delivery models, and their components, in a variety of oncology practice settings, especially those serving under-served populations; and evaluate the sustainability and scalability of these new delivery models. The long-term goal of this FOA is to reduce the morbidity and mortality caused by depression in patients with cancer.
IT-focused or behavioral health delivery-focused organizations that do not have experience with cancer care delivery research are strongly encouraged to develop collaborations with research organizations with expertise in cancer care delivery.
This FOA will utilize the Research Project Grant (R01) mechanism, and is suitable for projects where proof-of-principle of the proposed technology or methodology has already been established and supportive preliminary data are available.
This FOA runs in parallel with an FOA of similar scientific scope, PA-18-492, which utilizes the Exploratory/Developmental Grant (R21) mechanism.
Burden of Depression in Cancer
Depression is common in cancer; it worsens quality of life, decreases adherence to treatments, increases risk of suicides, and contributes to increased mortality in cancer patients. Several accurate screening and diagnostic instruments are available to identify patients with depression and there are many effective treatments. The US Preventive Services Task Force (USPSTF) recommends screening all adults for depression. The American Society of Clinical Oncology has issued guidelines on screening, assessment, and care of anxiety and depressive symptoms in adults with cancer. Collaborative care delivery models have been effectively used by oncologists to identify and treat patients with depression. Despite the availability of accurate screening and diagnostic instruments, effective treatments and care delivery models, depression in cancer patients is under-diagnosed and under-treated.
Barriers to Delivery of Depression Care
Studies have shown that, in the absence of screening, oncologists often fail to diagnose depression in cancer patients, and that many cancer patients with depression do not receive any effective depression treatment. Barriers to better management of depression in cancer patients include a shortage of mental health providers, especially in rural areas; difficulty in coordinating care among various clinicians; and inadequate patient-physician communication due to limited time during a clinic visit.
IT’s Potential in Overcoming Barriers to Delivery of Depression Care
IT can overcome several barriers to the delivery of depression care by oncologists. For example, telehealth can connect psychiatrists practicing in urban academic centers to community oncologists practicing in rural areas. Communication and clinical decision support tools can improve care coordination among providers. Patient-facing apps can help to schedule appointments and coordinate care with providers, and help with delivery of behavioral interventions. Patients can be screened for depression using mobile devices or computer kiosks in clinics prior to seeing an oncologist. The USPSTF recommends depression screening be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up of patients with depression. IT can support a systems-based approach to improve management of depression in cancer patients.
IT Affects Delivery of Care
Healthcare delivery systems are complex systems with many interacting components, including people, physical settings, information systems, communications, workflows and culture. Adoption of IT can affect workflows of individuals and teams and change organizational structure and processes. An electronic health record (EHR) is an example of an IT widely used in clinical practice. However, there is widespread dissatisfaction with the ease of use of EHRs. Poor usability increases clinician frustration and can lead to errors.
Design processes such as human-centered design, which involves the end-user throughout the product development and testing process, help to ensure IT meets the needs of end-users such as clinicians (working individually and in teams), patients and their caregivers. The development of user-friendly and useful IT tools and processes helps to ensure the long-term use (sustainability) of IT-enabled care delivery models and facilitates their adoption in diverse practice settings (scalability).
The goals of this FOA are to:
- Identify new, IT-enabled delivery models that support systematic screening and treatment of depression in cancer patients;
- Test the feasibility of implementing these new delivery models in a variety of oncology practice settings, especially those serving under-served populations;
- Test the effectiveness of these new delivery models, and their components, in a variety of oncology practice settings, especially those serving under-served populations; and
- Evaluate the sustainability and scalability of these new delivery models.
All oncology practice settings are within the scope of the FOA, including academic cancer centers, community cancer centers, medical oncology practices, radiation oncology practices and surgical oncology practices.
The FOA encourages research that uses established, evidence-based screening and diagnostic instruments to detect depression and proven, efficacious treatments for depression in the design and evaluation of new IT-enabled care delivery models. The design and evaluation considerations of the new delivery model should include its long-term use within an oncology practice setting (sustainability) and implementation across a variety of oncology practice settings (scalability).
The FOA encourages multi-disciplinary research; the team of investigators may include (but is not limited to) information technology experts, clinical epidemiologists, human factors engineers, industrial engineers, communication scientists, cognitive scientists, oncologists, nurses, psychologists, psychiatrists, primary care clinicians, medical sociologists, and social workers.
The FOA encourages the use of a variety of study designs, including randomized control trials, and the use of appropriate methods, which may include a mix of established quantitative and qualitative methods, to understand the feasibility of implementing new IT-enabled care delivery models and their effectiveness in improving patient outcomes as well as outcomes of clinicians, teams, and care delivery organizations. Outcomes of interest include, but are not limited to, those listed in the examples of research questions. The evaluation may also include consideration of the costs and cost-effectiveness of these new models.
The FOA encourages the use of methods such as cognitive work analysis, cognitive task analysis, workflow and task analyses, and human-centered design evaluations to understand how clinical work relevant to depression care is currently being done in an oncology practice setting, and how it can be improved. Since human interactions with IT are an important component of clinical work, the assessment of clinical work needs to include how IT is being used and how it can be redesigned to improve clinical work. An understanding of the clinical workflow and clinical needs in an oncology practice setting is essential to designing IT that is usable (user-friendly) and useful, which in turn will help to design effective, sustainable, and scalable IT-enabled care delivery models.
The FOA encourages the design of IT that may be used by clinicians (individuals or the entire team), patients, caregivers, or a combination of these users. The IT may be used to improve communication between patients or their caregivers and clinicians or between clinicians to improve care coordination. The IT may also be used to support delivery of evidence-based interventions. In addition, the IT may be used to collect data, share data, analyze data, present data for clinical decision support, or a combination of these data-specific uses. The IT design and implementation considerations need to include use of existing standards and best practices to facilitate interoperability between IT systems while protecting a patient’s privacy and ensuring compatibility with the care delivery organization’s cyber-security procedures and processes.
Examples of research questions that fall within the scope of the FOA include, but are not limited to:
- What is the effectiveness of the new, IT-enabled delivery models in improving depression-related outcomes in cancer patients compared to usual care?
- What is the effectiveness of the new delivery models in improving treatment adherence, patient-provider communication, and other cancer care delivery-related outcomes?
- What is the effectiveness of the new delivery models in improving provider- and system-level outcomes (e.g., provider satisfaction, timeliness in delivering care, and the efficient use of resources to diagnose and treat patients with depression)?
- What characteristics of the providers and practice settings influence effectiveness of the new delivery model?
- What characteristics of the patients and caregivers influence effectiveness of the new delivery model?
- What are the factors, including costs, availability of personnel, and organizational capacity, that affect the sustainability and scalability of the new delivery model?
- What are the effective approaches to sustainably implement the new delivery model in an oncology practice setting?
- What are the effective approaches to scale the implementation of the new delivery model to diverse oncology practice settings, especially those serving under-served populations?
- How do the components of the new delivery model (e.g., personnel, type of technology, integration in workflow, intensity of communication and monitoring) contribute to its effectiveness?
Deadlines: standard dates apply
- R01 – https://grants.nih.gov/grants/guide/pa-files/PA-18-493.html
- R21 – https://grants.nih.gov/grants/guide/pa-files/PA-18-492.html
Filed Under: Funding Opportunities