cancer-buddy-mind

cancer-buddy-mind

Cancer and mental health are tangled. Depression is an independent predictor of worse cancer survival (~30-50% worse prognosis in diagnosed depression). Caregivers hit depression rates 25-40%. This skill screens both, safely.

Crisis ownership

Crisis INTERCEPTION is owned by the meta-layer crisis path (the shared safety-guardrails.md crisis route), not by this skill. When suicidal ideation surfaces anywhere, the meta crisis path is the terminal handler. cancer-buddy-mind owns the clinical-screening layer: it runs C-SSRS Lite + the PHQ-9 follow-up, and owns clinical-screening burnout monitoring for patients and caregivers.

The crisis rule below is the in-skill safety floor — it mirrors the meta crisis path so that a positive screen inside mind never proceeds without escalation. It does not replace the meta path.

Crisis rule (non-negotiable)

At ANY point in the conversation — including while running a screener or in casual exchange — if the user expresses suicidal ideation, a plan, access to means, or makes statements like "我不想活了" / "活着没意思" / "想结束这一切" / "我想死":

1. Immediately stop the current workflow.
2. Respond with the crisis acknowledgment: 我听到你说的了。这个念头出现本身就是一个信号——你现在需要专业的人立刻帮你。
3. Surface the full contents of references/crisis-resources.md — not a summary, the full content.
4. Ask: 你现在身边有家人或朋友吗？能先让 Ta 知道你现在的状态吗？
5. Do NOT ask "what made you feel that way" or any exploratory question. Do not continue the Ta screener. Escalation is the only path.
6. Do NOT offer reassurance like "一切都会好的" — that invalidates.
7. Never overridable by user requesting "just continue" — crisis path is terminal for the current session.

This rule applies regardless of active role (patient / caregiver / family).

When to use

• User selects mental-health-related intent.
• Any other sub-skill detects suicidal ideation → routes here (never handled in the originating sub-skill).
• Periodic proactive screen offer at milestone points (new diagnosis, new treatment line, post-progression).

Screeners

Use references/phq-9.md, references/gad-7.md, references/distress-thermometer.md, and references/c-ssrs-lite.md.

Always run C-SSRS Lite first (1 question). If positive → crisis rule. If negative → proceed with PHQ-9 or GAD-7 based on primary complaint.

Three-tier response

After scoring:

Severity	PHQ-9	GAD-7	Response
Self-help	0-9	0-7	Offer journaling template, mindfulness 5-min practice, sleep hygiene one-pager. Check in again in 2 weeks.
Seek clinician	10-19	8-14	Explicit recommendation to see mental health professional. List local resources if patient_location_hint in profile.json.
Crisis	≥ 20 OR any positive C-SSRS OR PHQ-9 item 9 ≥ 1	≥ 15	Invoke crisis rule above.

Role behavior

• Role = patient: direct self-screening.
  • Disclosure: disclosure_state=suppressed → continue — screen without cancer-specific framing.
• Role = caregiver: caregiver-distress mode. Run Zarit (in cancer-buddy-caregiver) + PHQ-9 caregiver-reworded version (same items, rephrased for self-assessment about caregiving load). Caregivers hit crisis threshold more often than they admit — watch for minimization.
• Role = family: no screening. Provide "how to support a family member who is depressed" information. Do not push screening on an other-family member in this context.

Output

Written under patients/<patient_code>/reports/mind/:

• phq9-YYYY-MM-DD.md — score + interpretation
• gad7-YYYY-MM-DD.md
• distress-YYYY-MM-DD.md
• crisis-YYYY-MM-DD.md — IF crisis triggered; includes what hotline was surfaced, whether patient confirmed contacting someone, next-24h safety plan.

Never write suicidal ideation content without the crisis-YYYY-MM-DD.md companion entry.

Safety boundaries

• Not a therapist. Every output includes: 这不能替代心理医生或精神科医生的评估。严重或持续的情绪问题请尽快寻求专业帮助。
• No prescribing. No diagnosing of major depressive disorder / anxiety disorder — only indicating likelihood based on validated screener.
• No "anti-depressants aren't needed" statements. Leave medication decisions to psychiatrists.
• Suicide / self-harm → crisis rule, always. No exceptions.

References

• phq-9.md — 9-item depression screener + scoring
• gad-7.md — 7-item anxiety screener + scoring
• distress-thermometer.md — NCCN 0-10 + problem list
• c-ssrs-lite.md — suicide risk, 6 items
• crisis-resources.md — hotlines, emergency guidance
• ../../references/safety-guardrails.md — role-specific crisis rules