Advancing the Quality of Cancer Care through Behavioral Economics and Implementation Science

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The grand challenge addressed by the Penn Implementation Science Center in Cancer Control (Penn ISC3) is to apply insights from behavioral economics to accelerate the pace at which evidence-based practices for cancer care are deployed to improve outcomes and equity for individuals with cancer. Penn offers a unique environment in which to conduct this paradigm- shifting work, given our expertise in implementation science, behavioral economics, and innovative cancer care delivery. The complementary and multi-disciplinary expertise of the three MPIs (Beidas, Bekelman, Schnoll), coupled with existing Penn resources represent a unique opportunity to advance the quality of cancer care. Our partnership with Columbia University and Dr. Rachel Shelton will allow us to address critical questions regarding health equity. The Administrative Core will ensure that the activities of Penn ISC3 are coordinated, synergistic, and congruent with timelines. The Implementation Laboratory represents a diverse ecosystem that includes five hospitals and linked clinical sites, with over 200 oncologists that serve over 15,000 unique new patients annually. Our Research Program will oversee the development and testing of implementation strategies that target patients and clinicians within our Implementation Lab and are centered on the idea of `nudging' for optimal implementation and effectiveness outcomes. The Research Program includes investigators with expertise in implementation science, behavioral economics, cancer care delivery research, healthcare innovation, health equity, measurement, and mixed methods. In the first two years, we propose two Signature Pilot Projects and three Methods Projects. Signature Pilot Project 1 tests patient- and clinician-directed implementation strategies to increase referral to tobacco cessation programs among cancer patients. Signature Pilot Project 2 tests patient- and clinician-directed implementation strategies to increase serious illness conversations. Common methods and measures are linked to allow for pooling of data and to accomplish our objectives of testing multi-level implementation strategies and mechanisms across contexts. Three methods projects, in support of the Projects, will advance the science of implementation methods. Methods Project 1 will support the application of rapid cycle approaches; Methods Project 2 will use qualitative comparative analysis to characterize multilevel contextual variation. Methods Project 3 will provide methodological and theoretical support in incorporating a health equity lens to the methods, measures, frameworks, and strategies ap-plied across the SPPs. The Penn ISC3 has the potential to identify novel, disseminable, and scalable ways to advance the quality and equity of cancer care.