Adapting and implementing evidence-based breast cancer follow-up in primary care

在初级保健中调整和实施循证乳腺癌随访

• 批准号: 10316361
• 负责人: BENJAMIN F CRABTREE
• 金额: $ 65.05万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316361
• 关键词: Address; Adopted; Adoption; Aftercare; American Cancer Society; Biological Response Modifier Therapy; Breast Cancer Treatment; Breast Cancer survivor; Breast Cancer survivorship; Cancer Model; Cancer Survivor; Cancer Survivorship; Caring; Chronic Disease; Clinical; Clinical Management; Code; Complex; Consensus; Cost Analysis; Counseling; Development; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Effectiveness; Evaluation; Future; Guidelines; Health behavior; Healthcare; Healthcare Systems; Hybrids; Individual; Information Systems; Intervention; Interview; Knowledge; Learning; Literature; Long-Term Care; Long-Term Effects; Mental Health Services; Methods; Modeling; Monitor; Oncology; Patient Care; Patients; Policies; Policy Maker; Population; Positioning Attribute; Primary Health Care; Process; Protocols documentation; Provider; Public Advocacies; Radiation; Randomized; Recommendation; Recording of previous events; Recurrence; Research; Research Design; Research Personnel; Risk Management; Risk Reduction; Second Primary Cancers; Self Management; Services; Site; Structure; Symptoms; Testing; Translating; Waiting Lists; Work; base; chemotherapy; clinically actionable; concept mapping; design; effectiveness trial; evidence base; experience; follow-up; hormone therapy; implementation framework; implementation strategy; innovation; malignant breast neoplasm; multidisciplinary; primary care setting; public health relevance; receptor; research study; survivorship; sustainability framework; symptom management; uptake

PROJECT SUMMARY/ABSTRACT Breast cancer survivors are a growing population and their symptom burden is significant. Despite growing evidence on specific symptoms and risk management strategies, efforts to translate knowledge into practice have produced suboptimal results. Primary care is an ideal receptor site for breast cancer survivors, with studies demonstrating the effectiveness of primary care based survivorship care. Nevertheless, over the past decade, the emphasis on survivorship care plans and survivorship models has not had an evident impact on primary care breast cancer survivorship care processes. Over the past two decades, primary care practices have redesigned structures and care processes to deliver care to different complex populations; however, breast cancer survivors are not among them. Many currently proposed and tested strategies are considered oncology-centric and do not fit well within the real world contexts of primary care practices. Results from our recent research studies indicate that breast cancer survivorship is not considered clinically actionable even among primary care practices with advanced staffing models. Therefore, capacity building and stakeholder- informed strategies are needed to enhance the translational potential of survivorship evidence into primary care practices. This project uses a “designing for dissemination” perspective, blending the implementation Exploration, Planning, Implementation and Sustainment (EPIS) framework and the primary care Practice Change Model (PCM) as a theoretical basis for understanding multilevel factors impacting the implementation of cancer survivorship guidelines in primary care. These perspectives help frame and identify mismatches among existing policy, practice, provider, and patient motivators to translate the evidence into clinically actionable primary care practice change strategies. Using a blended implementation/primary care practice change conceptual framework, this project aims to: (1) engage diverse primary care stakeholders in identifying actionable, practice-based activities for provision of long-term breast cancer survivorship care in primary care using depth interviews; (2) prioritize, synthesize, and identify actionable activities for providing care to long- term cancer survivors in primary care by engaging key stakeholders using modified online Delphi methods and concept mapping; and (3) implement and evaluate actionable breast cancer survivorship symptom and risk management activities using a hybrid type 1 effectiveness-implementation cluster study design with waitlist control in 26 primary care practices. Study results are poised to have profound impact on implementation strategies used throughout the U.S. to provide long-term care for patients with a history of breast cancer.

项目概要/摘要 乳腺癌幸存者的人口不断增长，他们的症状负担也很严重。尽管成长 有关特定症状和风险管理策略的证据，以及将知识转化为实践的努力 产生了次优的结果。初级保健是乳腺癌幸存者的理想接受点 研究证明了基于初级保健的生存护理的有效性。尽管如此，过去 十年来，对幸存者护理计划和幸存者模型的重视并没有对 初级保健乳腺癌生存护理流程。过去二十年，初级保健实践 重新设计了结构和护理流程，为不同的复杂人群提供护理；然而， 乳腺癌幸存者不在其中。考虑了许多当前提出和测试的策略 以肿瘤学为中心，不太适合初级保健实践的现实世界背景。我们的结果 最近的研究表明，即使乳腺癌存活率不被认为具有临床可操作性 具有先进的人员配置模式的初级保健实践。因此，能力建设和利益相关者 需要采取明智的策略来增强将幸存者证据转化为初级证据的潜力 护理实践。该项目采用“传播设计”的视角，融合实施 探索、规划、实施和维持 (EPIS) 框架和初级保健实践 变革模型 (PCM) 作为理解影响实施的多层次因素的理论基础 初级保健中的癌症生存指南。这些观点有助于构建和识别不匹配的情况 在现有的政策、实践、提供者和患者的激励因素中，将证据转化为临床 可行的初级保健实践变革策略。使用混合实施/初级保健实践 改变概念框架，该项目旨在：(1) 让不同的初级保健利益相关者参与确定 在初级保健中提供长期乳腺癌生存护理的可行的、基于实践的活动 采用深度访谈； (2) 优先考虑、综合并确定为长期护理人员提供护理的可行活动 通过使用修改后的在线德尔菲法让关键利益相关者参与进来，在初级保健中帮助足月癌症幸存者 概念图； (3) 实施和评估可操作的乳腺癌生存症状和风险 使用带有候补名单的混合 1 类有效性实施集群研究设计的管理活动 控制 26 个初级保健机构。研究结果将对实施产生深远影响 美国各地使用的策略为有乳腺癌病史的患者提供长期护理。