Implementing an integrated mental health care model to reduce distress in Veterans with cancer

About This Grant

Significance to VA. Half of the 500,000 Veterans receiving cancer care in VA will encounter distress, a multifactorial psychological, social, spiritual, and/or physical experience that may interfere with one’s ability to cope effectively with cancer. Distress has major implications – decreased likelihood of completing cancer therapy, worse quality of life, more emergency room visits and hospitalizations, and higher mortality, including suicide. The collaborative care model (CoCM) is a proven delivery mechanism for evidence-based treatments that can reduce the negative impacts of distress. However, despite its evidence base, no VA medical centers (VAMCs) currently use CoCM to treat distress. Meanwhile, two out of three Veterans with distress do not receive care. To improve the quality of life and overall survival of Veterans living with cancer, the proposed research aims to understand why CoCM is not widely implemented and how CoCM could be successfully utilized in VA’s diverse care settings. This research directly addresses the major challenge facing VA of providing high-quality, highly-efficient mental health care for a rapidly growing population of Veterans facing life with cancer. It tackles top HSR and VA priorities – mental health & suicide prevention; access to high-quality, integrated health care; and use of foundational learning health systems methods in implementation science and engagement science. Innovation & Impact. This project will use innovative, patient- and clinician-centered implementation science techniques to create key constituent-informed, feasible, and acceptable implementation strategies for use of CoCM in VA cancer care. Specific Aims. Aim 1: Identify current distress care practices and potential determinants (i.e., barriers and facilitators) of CoCM in VA cancer care. Aim 2: Develop implementation strategies for use of CoCM in cancer care with key constituents. Aim 3: Assess the feasibility and acceptability of implementation protocols and materials at three VISN 10 sites. Methodology. Aim 1 uses a two-part study design: 1) semi-structured interviews with key constituents (patients (n=15), clinicians (n=18)) from three VAMCs currently participating in the VA Office of Mental Health’s Mental Health Integration in Oncology Clinics pilot project to understand acceptability and potential determinants of CoCM and 2) a national survey of VA medical oncologists to identify the workforce and workflows currently used to address distress across VA. Aim 2 uses a panel of key constituents (n=18 including two patients) to identify implementation outcomes, select implementation strategies, and produce implementation protocols and materials supporting CoCM use in VA cancer care. Aim 3 uses a mixed-methods, user-centered design approach to determine the feasibility and acceptability of the protocols and materials designed in Aim 2 through “think-aloud,” semi-structured interviews with and quantitative surveys of end-users (n=12, oncology and mental health clinicians) from three different VISN 10 sites. Path to Translation/Implementation. Future work will aim to 1) determine the quality of and preferences for distress care among women and young adult Veterans living with cancer – two quickly growing populations within VA who may have unique distress care needs that CoCM will need to meet (Year 3 IIR) and 2) conduct a multi-site, randomized, hybrid effectiveness-implementation trial in VISN 10 of the implementation strategies created in this proposal (Year 5 IIR). Understanding how to implement CoCM in cancer care will impact individuals with cancer broadly as non-VA health care settings also face gaps in distress care. The long-term goal of this research is widespread implementation of CoCM in VA cancer care to ultimately improve the quality and quantity of life of Veterans living with cancer. .