TEAMSPORT to Community TEAMSPORT: Validating and Adapting a Precision Oncology Reflex Testing Team Intervention to Reduce Rural Disparities in Cancer Care Delivery

项目摘要/摘要 每年有50万被诊断为癌症的美国人有肿瘤可以成为FDA的目标-- 批准的药物可以更有效地治疗他们的疾病。然而，这些治疗方法的使用有很大的差异。 在临床实践中。农村患者比非农村患者更有可能死于癌症， 不太可能接受有针对性的癌症治疗，并可能从针对这一质量的干预措施中受益匪浅 差距。本研究将测试我们的多团队系统框架Precision Oncology Reflex的有效性 测试(TeamSports)干预，以标准化靶向癌症治疗的交付并使其适用于 农村和非农村社区癌症计划，在那里大多数癌症患者得到他们的护理。 我们经验丰富的多学科团队，由分子病理学家、医学肿瘤学家、农村实施人员组成 科学家和团队系统科学家将通过以社区为基础的社区咨询委员会进行扩充 病理学家、肿瘤学家、癌症项目管理人员和癌症网络领导人 大约1,000个社区肿瘤学项目。他们将共同确保最尖端的证据- 以精确肿瘤学为基础的科学将得到有效团队间协调和最佳做法的支持 包装为农村和非农村社区癌症项目的最佳吸收。 在此模块R01中，响应NCI的优先事项，评估技术分散和 进一步的团队系统科学，我们将进行中断的时间序列研究，以测试 团队运动对指南一致性基因组测试和团队协调的干预。我们会 同时与社区合作者合作，使干预措施适应社区环境，并测试其 社区癌症项目大样本的可接受性、可行性、适当性和可采纳性。 这项科学研究将导致： 1)一个基于证据的工具包，以增加对基因组测试和靶向癌症治疗的适当使用， 适用于农村和非农村社区癌症项目 2)多团队系统干预的有效性的首批测试之一，以及关系的影响 协调，一个有效的团队连接性衡量标准，关于护理质量 3)未来实践中使用的多团队系统干预的效果大小-随机试验 4)当地认可的精确肿瘤学测试和报告最佳实践方案 5)一个新的审计和反馈平台，供各机构评估对建议的国家准则的遵守情况 精确肿瘤学实践 最终，这项研究有可能在癌症护理提供者中带来更大的工作满意度；更广泛和 更及时地使用基因组检测和适当的癌症治疗；患者获得更好的癌症结果； 减少不必要治疗带来的危害；缩小城乡癌症差距。

PROJECT SUMMARY/ABSTRACT Each year >500,000 Americans diagnosed with cancer have tumors that could be targeted with an FDA- approved drug to treat their disease more effectively. However, there is wide variation in use of these treatments in clinical practice. Rural patients, who are more likely to die from cancer than their non-rural counterparts, are less likely to receive targeted cancer therapies and could benefit greatly from interventions to address this quality gap. This study will test the effectiveness of our Multi-TEAM Systems Framework Precision Oncology Reflex Testing (TEAMSPORT) intervention to standardize delivery of targeted cancer therapy and adapt it for use in rural and non-rural community cancer programs, where the majority of cancer patients receive their care. Our experienced multidisciplinary team of molecular pathologists, medical oncologists, rural implementation scientists, and team system scientists will be augmented by a Community Advisory Board of community-based pathologists, oncologists, cancer program administrators, and cancer network leaders representing approximately 1,000 community oncology programs. Together they will ensure the most cutting-edge, evidence- based precision oncology science will be supported by best practices in effective inter-team coordination and packaged for optimal uptake by rural and non-rural community cancer programs. In this modular R01, responsive to NCI priorities to evaluate geographic disparities in technology dispersion and further team system science, we will conduct an interrupted time series study to test the effectiveness of the TEAMSPORT intervention on guideline-concordant genomic testing and team coordination. We will simultaneously work with community collaborators to adapt the intervention to community settings and test its acceptability, feasibility, appropriateness, and adoptability among a large sample of community cancer programs. This scientific study will result in: 1) An evidence-based toolkit to increase appropriate use of genomic testing and targeted cancer therapy, suitable for rural and non-rural community cancer programs 2) One of the first tests of the effectiveness of a multi-team system intervention, and the impact of relational coordination, a validated measure of team connectedness, on quality of care 3) Effect sizes of a multi-team system intervention for use in future practice-randomized trials 4) Locally-endorsed, best practice protocols for precision oncology testing and reporting 5) A novel audit and feedback platform for institutions to assess adherence to national guideline recommended precision oncology practices Ultimately, this study has potential to lead to greater job satisfaction among cancer care providers; wider and more timely use of genomic testing and appropriate cancer therapies; better cancer outcomes for patients; reduced harms from unnecessary treatment; and a reduction in rural-urban cancer disparities.