{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:31:43Z","timestamp":1790368303687,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR000062"],"award-info":[{"award-number":["UL1 TR000062"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01 CA281740"],"award-info":[{"award-number":["R01 CA281740"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R42 MH108219"],"award-info":[{"award-number":["R42 MH108219"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although depression is prevalent and has significant consequences among individuals living with likely incurable cancer (ILLIC), optimal methods of identifying and treating depression in this population remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate a paradigm of (1) proactive identification (ID) (i.e.,\u00a0remotely and asynchronously from clinical encounters) of depression among ILLIC and (2) digital mental health intervention (DMHI) for depression treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this decentralized randomized clinical trial, ILLIC with elevated depressive symptoms were proactively identified using electronic health record data and randomized 2:1 to a DMHI\u2010based Behavioral Activation treatment or usual care (UC) depression treatment. Measures of feasibility (accrual, retention) and acceptability (engagement) were described; depression severity (change in PHQ\u20109 scores through 4\u00a0weeks post\u2010randomization) was modeled with a generalized estimating equation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 88 ILLIC who completed screening, 30 were eligible and randomized to the trial. No patients were lost to follow\u2010up or withdrew; 80% of patients randomized to proactive ID\u00a0+\u00a0DMHI used the app through 4\u00a0weeks. Proactive ID\u00a0+\u00a0DMHI improved depression from baseline to 4\u00a0weeks relative to proactive ID\u00a0+\u00a0UC (mean difference in change from baseline to week 4\u00a0=\u00a0\u22122.7; 90% CI: \u22124.9 to \u22120.4). At 4\u00a0weeks, the odds of a clinical response (PHQ\u20109 decrease of \u2265\u00a05 points) was 9.0\u2010fold higher for patients in proactive ID\u00a0+\u00a0DMHI relative to proactive ID\u00a0+\u00a0UC (OR 9.0; 90% CI: 1.1\u201374.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A proactive ID\u00a0+\u00a0DMHI approach to identifying and treating depression among ILLIC is feasible, acceptable, and potentially efficacious. These promising data support conducting a large efficacy trial evaluating this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov identifier: NCT05932810<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70309","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:48:53Z","timestamp":1761184133000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Proactive Identification and Digital Mental Health Intervention for the Treatment of Depression Among Individuals With Likely Incurable Cancer: A Pilot Randomized Clinical Trial"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3766-468X","authenticated-orcid":false,"given":"Evan M.","family":"Graboyes","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Levins","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reid","family":"DeMass","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivetha","family":"Baskar","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelle","family":"Natale","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Sterba","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihad S.","family":"Obeid","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Sharma","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth G.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dahne","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina 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