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

项目摘要/摘要 乳腺癌幸存者是一个不断增长的人口，他们的症状负担很大。尽管不断增长 关于具体症状和风险管理战略的证据，将知识转化为实践的努力 都产生了不太理想的结果。初级保健是乳腺癌幸存者理想的受体场所， 证明以初级保健为基础的生存护理有效性的研究。尽管如此，在过去的一段时间里， 十年来，对生存护理计划和生存模式的重视没有对以下方面产生明显影响 初级保健乳腺癌生存护理流程。在过去的二十年里，初级保健实践 重新设计了结构和护理流程，以向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并经过测试的策略 以肿瘤学为中心，不能很好地适应初级保健实践的现实环境。结果来自我们的 最近的研究表明，乳腺癌的存活率甚至不被认为是临床上可行的。 在初级保健实践中采用先进的人员配备模式。因此，能力建设和利益攸关方-- 需要知情的战略来加强将生存证据转化为初级证据的潜力 护理实践。该项目采用了“为传播而设计”的观点，融合了实施 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 癌症生存指南在初级保健中的应用。这些视角有助于框定和识别不匹配 在现有的政策、实践、提供者和患者激励因素中，将证据转化为临床 可操作的初级保健实践改变战略。采用混合实施/初级保健做法 改变概念框架，该项目旨在：(1)让不同的初级保健利益攸关方参与确定 在初级保健中提供长期乳腺癌生存护理的可操作的、以实践为基础的活动 使用深度访谈；(2)确定优先顺序、综合和确定可操作的活动，以便为长期- 通过使用改进的在线Delphi方法吸引关键利益相关者参与，将癌症幸存者延长到初级保健中 概念图；以及(3)实施和评估可操作的乳腺癌生存症状和风险 使用混合类型1有效性的管理活动--实施具有等待名单的集群研究设计 控制26个初级保健诊所。研究结果将对实施产生深远影响 美国各地使用的为有乳腺癌病史的患者提供长期护理的策略。

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.