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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Hatcher S, Heisel MJ, Ayonrinde O, Corsi D, Edgar NE, Kennedy SH, Rizvi SJ, Schaffer A, Sinyor M. The BEACON study: an update to the protocol for a cohort study as part of an evaluation of the effectiveness of smartphone-assisted problem-solving therapy in men who present with intentional self-harm to emergency departments in Ontario. Trials 2022; 23:849. [PMID: 36199120 PMCID: PMC9532822 DOI: 10.1186/s13063-022-06788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who present to the emergency department (ED) with self-harm are at high risk of dying by suicide, with 2.7% of men dying in the year following their presentation, more than double the rate for women (1.2%). Despite this, care received after an ED visit is highly variable and many are not assessed for psychological needs. Furthermore, the limited psychological care that is available is often not covered by provincial health insurance. Even when referrals for follow-up care are made, engagement rates are low. Previous recommendations to improve engagement include written discharge plans, caring contacts, and focused interventions targeting middle-aged men at elevated risk of dying by suicide. Blended care, the incorporation of technology into traditional care, has also been proposed as a method to increase engagement in and clinical benefits from psychotherapy. This project aims to determine whether the delivery of an evidence based treatment (problem-solving therapy (PST)) is enhanced by the addition of a custom smartphone application (BEACON) compared to usual care. Due to the impact of the COVID-19 pandemic on site participation and the planned implementation, we have made several changes to the study design, primary outcome, and implementation. METHOD We originally proposed a cohort study nested within a larger cluster randomized trial wherein intervention sites would deliver the blended care, and control sites, whose personnel were not aware of their participation, would continue delivering usual care. The cohort study evaluated participant level outcomes as previously described by Hatcher et al. (2020). Due to pandemic-related constraints, our number of participating sites dropped to five potential sites which left the cohort study underpowered. As such, we changed the study design to a multi-site, individual randomized controlled trial (RCT) among the five remaining sites. Participants will be randomized to six sessions of therapy (PST) alone, or to the therapy plus BEACON, and followed up for 6 months. Our primary outcome was changed to evaluate feasibility and acceptability with the aim of designing a definitive RCT. Study implementation was reimagined to allow for completely virtual/online conduct to comply with local COVID-19 and institutional restrictions on in-person activities. CONCLUSION This updated protocol will provide strong results for the planning of a definitive RCT of the blended care intervention in the future, addressing areas of difficulty and concern prior to its implementation. We will evaluate the feasibility of the study intervention, assess recruitment and retention of participants, and address challenges with implementing the protocol. Lastly, we will evaluate the appropriateness of our primary outcome measure and accurately determine a sample size for a definitive RCT. TRIAL REGISTRATION ClinicalTrials.gov, NCT03473535 . Registered on March 22, 2018.
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Affiliation(s)
- Simon Hatcher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada. .,Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON, Canada. .,Department of Mental Health, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada.
| | - Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Western University, Parkwood Institute, Mental Health Care Building, London, ON, F4-365, Canada.,Department of Psychiatry, Lawson Health Research Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Oydeji Ayonrinde
- Department of Psychiatry, Queen's University, 752 King Street West, Postal Bag 603, Kingston, ON, Canada.,Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, Canada
| | - Daniel Corsi
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada
| | - Nicole E Edgar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - Sidney H Kennedy
- Centre for Depression & Suicide Studies, St. Michael's Hospital, 193 Yonge St. Suite 6-001A, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada
| | - Sakina J Rizvi
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada.,ASR Suicide and Depression Studies Unit, St. Michael's Hospital, 193 Yonge St, 6-009, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2374, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada
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Hatcher S, Werier J, Edgar NE, Booth J, Cameron DWJ, Corrales-Medina V, Corsi D, Cowan J, Giguère P, Kaluzienski M, Marshall S, Mestre T, Mulligan B, Orpana H, Pontefract A, Stafford D, Thavorn K, Trudel G. Enhancing COVID Rehabilitation with Technology (ECORT): protocol for an open-label, single-site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms. Trials 2022; 23:728. [PMID: 36056372 PMCID: PMC9437413 DOI: 10.1186/s13063-022-06578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As of May 2022, Ontario has seen more than 1.3 million cases of COVID-19. While the majority of individuals will recover from infection within 4 weeks, a significant subset experience persistent and often debilitating symptoms, known as "post-COVID syndrome" or "Long COVID." Those with Long COVID experience a wide array of symptoms, with variable severity, including fatigue, cognitive impairment, and shortness of breath. Further, the prevalence and duration of Long COVID is not clear, nor is there evidence on the best course of rehabilitation for individuals to return to their desired level of function. Previous work with chronic conditions has suggested that the addition of electronic case management (ECM) may help to improve outcomes. These platforms provide enhanced connection with care providers, detailed symptom tracking and goal setting, and access to relevant resources. In this study, our primary aim is to determine if the addition of ECM with health coaching improves Long COVID outcomes at 3 months compared to health coaching alone. METHODS The trial is an open-label, single-site, randomized controlled trial of ECM with health coaching (ECM+) compared to health coaching alone (HC). Both groups will continue to receive usual care. Participants will be randomized equally to receive health coaching (± ECM) for a period of 8 weeks and a 12-week follow-up. Our primary outcome is the WHO Disability Assessment Scale (WHODAS), 36-item self-report total score. Participants will also complete measures of cognition, fatigue, breathlessness, and mental health. Participants and care providers will be asked to complete a brief qualitative interview at the end of the study to evaluate acceptability and implementation of the intervention. DISCUSSION There is currently little evidence about the optimal treatment of Long COVID patients or the use of digital health platforms in this population. The results of this trial could result in rapid, scalable, and personalized care for people with Long COVID which will decrease morbidity after an acute infection. Results from this study will also inform decision making in Long COVID and treatment guidelines at provincial and national levels. TRIAL REGISTRATION ClinicalTrials.gov NCT05019963. Registered on 25 August 2021.
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Affiliation(s)
- Simon Hatcher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Joel Werier
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- Ontario Workers Network, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Nicole E. Edgar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
| | | | - D. William J. Cameron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Division of Infectious Diseases, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Vicente Corrales-Medina
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
| | - Daniel Corsi
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Juthaporn Cowan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON Canada
- Centre of Infection, Immunity, and Inflammation, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Pierre Giguère
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Pharmacy, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- School of Pharmaceutical Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Shawn Marshall
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Division of Physical Medicine and Rehabilitation, University of Ottawa, 505 Smyth Road, Ottawa, ON Canada
- Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON Canada
| | - Tiago Mestre
- Parkinson’s Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON Canada
- Neuroscience Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
- University of Ottawa Brain and Mind Research Institute, 451 Smyth Road, Ottawa, ON Canada
| | - Bryce Mulligan
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, ON Canada
| | - Heather Orpana
- Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON Canada
| | - Amanda Pontefract
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Darlene Stafford
- Ontario Workers Network, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Guy Trudel
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
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