权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

基本信息

批准号：
10436995
负责人：
BENJAMIN F CRABTREE
金额：
$ 63.81万
依托单位：
RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10436995
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 translational potential uptake

项目摘要

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.

项目总结/文摘