CoCM-PAL: Adapting Collaborative Care for Older Adults with Serious Illness and Comorbid Depression or Anxiety Receiving Ambulatory Palliative Care
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Project Summary/Abstract Dr. Daniel Shalev is an Assistant Professor of Medicine and Psychiatry at Weill Cornell with expertise in psychiatry, palliative medicine, and behavioral geriatrics. His career goals are to 1) become a leading investigator in mental health delivery for older adults with serious illness and thereby 2) to improve mental health outcomes for older adults with serious illness. Research: Over 70% of deaths in the United States are due to chronic illness. The burden of serious medical illnesses like cancer, heart failure, and chronic lung disease falls disproportionately on older adults. As the population of older adults grows, so too will the impact of serious chronic illnesses. The standard of care for older adults with serious illness includes geriatric palliative care, a multidisciplinary approach to palliative care that emphasizes longitudinal care, multimorbidity, and quality of life. Psychiatric and psychological symptoms like depression and anxiety are common among older adults living with serious illness and have a significant impact on outcomes such as quality of life. Mental health is a core focus of palliative care. Older adults face distinct barriers to accessing mental health care that make them particularly likely to depend on palliative care clinicians for mental health services. However, palliative care clinicians may face barriers to assessing and managing such symptoms leading to gaps in care. The objective of this proposal is to adapt the Collaborative Care Model to the palliative care setting to improve depression and anxiety care for older adults. The Collaborative Care Model integrates mental health services into medical care that has been validated in over 90 clinical trials. The model involves embedding a social worker and psychiatrist in a medical setting to provide direct patient care and guide medical clinicians in improving their mental health skills and knowledge. This study will utilize the Method for Program Adaptation through Community Engagement, an intervention adaptation method co-designed by Dr. Shalev’s primary mentor Dr. Cary Reid, to create the Collaborative Care Model for Palliative Care (CoCM-PAL) (Aim 1) and to conduct a pilot randomized controlled trial of CoCM-PAL (Aim 2). Completion of the proposed study will generate key pilot data for a large efficacy trial of CoCM-PAL. Career Development: Dr. Shalev has assembled a multidisciplinary team of mentors (Primary Mentor: Dr. Cary Reid, Co-Mentors: Dr. Vicki Jackson, Dr. Jesse Fann, and Dr. Catherine Riffin) and advisors (Dr. Harold Pincus, Dr. Kelly McConnell, Dr. Mark Lachs) with expertise in geriatric serious illness care, geriatric mental health, and Collaborative Care. His career development plan focuses on training in 1) behavioral intervention/design and clinical trials for older adults with serious illness 2) integration of implementation science into early phase of intervention research, 3) clinical care of older adults with both serious illness and mental health needs, and 4) leadership and grant writing. This Beeson award will provide Dr. Shalev with the skills, experience, and mentorship to become a leading investigator in mental health services for older adults with serious illness.
