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.

PROJECT NARRATIVE Depression is a significant problem in cancer care, it is under detected and despite the expansion of evidence- based treatments, most patients with depression in oncology settings do not receive treatment. The objective of this project is to develop and evaluate the usability, feasibility and acceptability of an innovative pathway to online evidence-based treatment for depression (iPath*D) as a means of increasing mental health literacy, screening rates and treatment access in oncology settings. The results are expected to have a major positive impact by providing proof-of-principle for the use of an online pathway to evidence based treatment with the potential for reaching an unprecedented number of patients with cancer who have unmet mental health needs.