An Intervention to Reduce Cancer Associated Thrombosis Through Improved Prophylaxis

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Candidate: Jordan Schaefer, MD is a hematologist and early clinical investigator specializing in antithrombotic therapies, with particular interests in implementation science and cancer associated thrombosis (CAT). Training Aims: This K01 career development award will facilitate Dr. Schaefer receiving training in qualitative research methods and analysis. Furthermore, he will develop skills in implementation science, including implementation mapping, and conducting a multicenter pilot implementation intervention. He will acquire these skills through focused mentorship meetings, formal coursework, workshops and seminars, and experiential learning. Long term, he will use this training to optimize and implement multicomponent interventions to promote best antithrombotic therapies. Research Context: CAT is a leading cause of death among patients with cancer. Studies have shown a net benefit to anticoagulant thromboprophylaxis for high-risk patients with cancer receiving systemic cancer therapy. Guidelines have broadly endorsed offering apixaban or rivaroxaban for this patient population, but uptake has been extremely low. An academic medical center was able to increase prophylaxis rates to over 90% of eligible patients. However, this intervention is not generalizable to community settings where most patients receive their care. The short-term goal of this proposal is to identify strategies to improve rates of CAT prophylaxis rates in low resource, community settings with a long-term goal of broadly disseminating this intervention to reduce the incidence of CAT. Specific Aims: AIM 1–To identify determinants of CAT prophylaxis in community-based oncology care settings to develop a strategy for improving CAT prophylaxis. AIM 2–To develop an implementation plan to improve the uptake of pharmacologic prophylaxis for CAT using implementation mapping. AIM 3–To pilot an implementation intervention at community-based oncology practices. Research Plan: To accomplish these aims, Dr. Schaefer will perform semi-structured interviews based on the Theoretical Domains Framework at several oncology practices. He will meet regularly with diverse stakeholders and use implementation mapping to establish a multicomponent implementation plan. Finally, he will conduct a pilot test of the intervention and assess implementation outcomes six oncology clinics. Research Environment: Dr. Schaefer is supported by a dedicated, multidisciplinary team of accomplished mentors and advisors with whom he has previously collaborated. The project will be supported by the Michigan Oncology Quality Consortium, the Michigan Anticoagulation Quality Improvement Initiative, and make use of several resources available at the University of Michigan, including the Institute for Healthcare Policy and Innovation. Summary: Completing this project will establish the foundation for a larger, multicenter study to establish the clinical efficacy and sustainability of this intervention. The training from this award will prepare Dr. Schaefer to submit a successful R01 application and achieve research independence using implementation science principles to address complex anticoagulation problems.