Behavioral Activation and Medication Optimization For Improving Perioperative Mental Health In Older Adults Undergoing Oncologic Surgery

Washington University School of Medicine105 enrolled

Overview

Using a Hybrid Type 1 Effectiveness-Implementation randomized control trial (RCT) design, the investigators will test the effectiveness of a bundled behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing oncologic surgery (compared with usual care), while examining implementation outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

105

Conditions

Older Adults Anxiety Depression Major Surgical Resection of a Thoracic Malignancy Major Surgical Resection of an Abdominal Malignancy

Interventions

Behavioral ActivationBEHAVIORAL

The behavioral intervention will consist of behavioral activation (BA), the basic premise of which is to help people with mental health problems to engage in activities that are reinforcing or meaningful and guided by their personal values

Medication OptimizationOTHER

Medication optimization consists of a simple set of principles: reconcile patient's medications, identify the patient's likely need for, and interest in, a medication adjustment, make the adjustment, and assess the response to that adjustment.

Usual care resourcesOTHER

List of resources that the patient can explore on their own

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: Pre-screening: To be considered for participation, patients will be screened using PHQ-4 questionnaire. Scores \>3 will indicate positive pre-screen (i.e. can be considered for participation and formal screening). Scores \< 3 will indicate negative screen (i.e. patient not considered for formal screening due to low risk for anxiety or depression). Screening: * Adults age ≥60 years * Scheduled major thoracic, breast, or abdominal surgery for suspected or confirmed malignancy * PHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale) ≥10 indicating clinically significant depression or anxiety symptoms. Exclusion Criteria: * Barrier to communication (Unable to read, speak, and understand English) * Severe cognitive impairment screened by the SBT (Short Blessed Test) \>10 * Acutely suicidal * Considered ineligible per the discretion of the oncologic surgeon or study PI * Previous participation in this study or another CPMH study of the intervention bundle or its feasibility.

Outcomes

Primary Outcomes

Change in depression as measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)

* 9 item questionnaire with answers ranging from 0=not at all to 3=nearly every day. * Scores represent: 0-5=mild, 6-10=moderate, 11-15=moderately severe, and 16-20=severe depression.

Time frame: Baseline, 1-month follow-up, and 3-month follow-up

Change in anxiety as measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)

* 7 item questionnaire with answers ranging from 0=not at all to 3=nearly every day. Total score for the seven items ranges from 0 to 21. * Scores 0-5=mild anxiety, 6-10=moderate anxiety, 11-15=moderately severe anxiety, and 15-21=severe anxiety.