Increasing Completion of Daily Patient-Reported Outcomes in Psychotherapies for Late-Life Depression through User-Centered Design

Background: Treatment of depressive symptoms in older adults is a growing public health concern. Collecting patient-reported outcomes (PROs) may facilitate efficiently scaling psychotherapy for older adults but user-specific tailoring is needed to improve completion.

Objectives: This study investigates (1) the effect of updating PRO collection tools for middle-aged and older adults with depressive symptoms through a user-centered design process on user completion of PRO questions, (2) what sociodemographic factors correspond with participant completion, and (3) how completion of PRO questions change during the course of a psychotherapy intervention.

Methods: Analysis was conducted on 139 middle-aged and older adults with depressive symptoms from three clinical trials at the Weill Cornell ALACRITY Center. Overall response percentages to daily PRO questionnaires were compared before and after the implementation of findings from a multiphase user-centered design process. Grouped least absolute shrinkage and selection operator (LASSO) was employed to examine which baseline factors correspond with patient completion and linear regression was conducted to explore the association. Changes in daily dichotomized completion over time were analyzed with mixed-effect logistic regression.

Results: After user-centered updates, there was a significantly higher (p < 0.001) percentage of completion (mean [standard deviation (SD)] percentage, 67.0 [35.6]%) than before (mean [SD] percentage, 24.9 [28.9]%). Additional years of education, age, and total annual household income greater than $25,000 were significant with completion percentage. Mixed-effects logistic regression showed that the odds of high completion increased each day (OR = 1.019 [95% CI: 1.014, 1.023; p < 0.001]).

Conclusion: This study has shown that user-centered technology tailoring may be associated with increased PRO completion among middle-aged and older adults with depressive symptoms. PRO-supported psychotherapies are promising for middle-aged and older adults with depressive symptoms. Likewise, this study has demonstrated the potential benefits of employing a rigorous user-centered design process with PRO technology.