Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
Oncologist. 2019 Jul;24(7):901-910. doi: 10.1634/theoncologist.2018-0488. Epub 2019 Jan 29.
Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative care trial for SMI and cancer.
SUBJECTS, MATERIALS, AND METHODS: We developed the Bridge intervention for patients with SMI (schizophrenia, bipolar disorder, and severe major depression) and cancer. Bridge includes proactive identification of SMI, person-centered care from a psychiatrist and case manager, and collaboration with oncology. We conducted a 12-week, single-group trial in patients with SMI and a new breast, gastrointestinal, lung, or head/neck cancer. We assessed the feasibility of patient identification, enrollment and study completion; evaluated acceptability and perceived benefit with exit interviews with patients, caregivers, and oncology clinicians; and examined change in psychiatric symptoms with the Brief Psychiatric Rating Scale (BPRS).
From November 2015 to April 2016, 30/33 eligible patients (90.9%) enrolled, and 25/29 (86.2%) completed assessments at all timepoints, meeting feasibility criteria. Of 24 patients, 23 (95.8%) found meeting with the psychiatrist helpful; 16/19 caregivers (84.2%) shared that Bridge addressed key caregiving challenges. Oncology clinicians evaluated Bridge as "very" or "most" useful for 94.3% of patients. Exit interviews with all participant groups suggested that Bridge fostered patient-clinician trust, increased access to psychiatric treatment, and enabled patients to initiate and complete cancer treatment. Psychiatric symptoms on the BPRS improved from baseline to 12 weeks.
Bridge is a feasible and acceptable care delivery model for patients with SMI, their caregivers, and oncology clinicians. Randomized trials are warranted to assess the efficacy of improving cancer outcomes in this underserved population.
Serious mental illness affects 13 million U.S. adults who experience increased cancer mortality. To improve outcomes, new models of integrated oncology and mental health care are urgently needed. This study found that it was feasible to identify, enroll, and retain patients with serious mental illness and a new cancer in a trial of integrated mental health and cancer care (Bridge). Patients, caregivers, and oncologists reported that Bridge facilitated the initiation and completion of cancer care. Randomized trials are warranted to investigate the impact on cancer outcomes. Trial procedures may inform consent, engagement, and trial retention for patients with mental illness.
由于癌症治疗方面的不平等，患有严重精神疾病（SMI）的个体的癌症死亡率增加。在癌症诊断时进行精神科护理可能会改善护理的提供，但缺乏将精神病学和癌症护理相结合的模式。我们评估了针对 SMI 和癌症的以患者为中心的协作护理试验的可行性和可接受性。
受试者、材料和方法：我们为患有 SMI（精神分裂症、双相情感障碍和严重抑郁症）和癌症的患者开发了 Bridge 干预措施。Bridge 包括主动识别 SMI、精神科医生和个案经理提供的以患者为中心的护理以及与肿瘤学的合作。我们对新诊断患有乳腺癌、胃肠道癌、肺癌或头颈部癌的 SMI 患者进行了为期 12 周的单组试验。我们评估了患者识别、入组和研究完成的可行性；通过对患者、护理人员和肿瘤学临床医生进行退出访谈来评估可接受性和感知益处；并通过简明精神病评定量表（BPRS）检查精神病症状的变化。
从 2015 年 11 月至 2016 年 4 月，33 名符合条件的患者中有 30 名（90.9%）入组，29 名中有 25 名（86.2%）完成了所有时间点的评估，符合可行性标准。24 名患者中，23 名（95.8%）认为与精神科医生会面有帮助；19 名护理人员中有 16 名（84.2%）表示 Bridge 解决了关键的护理挑战。肿瘤学临床医生评估 Bridge 对 94.3%的患者“非常”或“最”有用。所有参与者组的退出访谈都表明，Bridge 促进了医患信任，增加了获得精神科治疗的机会，并使患者能够开始和完成癌症治疗。BPRS 上的精神病症状从基线到 12 周时有所改善。
Bridge 是一种为 SMI 患者、他们的护理人员和肿瘤学临床医生提供的可行且可接受的护理提供模式。有必要进行随机试验来评估改善这一服务不足人群的癌症结局的疗效。
严重精神疾病影响着美国 1300 万成年人，使他们的癌症死亡率增加。为了改善结果，迫切需要新的综合肿瘤学和心理健康护理模式。这项研究发现，在一项综合心理健康和癌症护理试验（Bridge）中，识别、招募和留住患有严重精神疾病和新发癌症的患者是可行的。患者、护理人员和肿瘤学家报告说，Bridge 促进了癌症护理的启动和完成。需要进行随机试验来调查对癌症结果的影响。试验程序可以为精神病患者的知情同意、参与和试验保留提供信息。
