Implementing Prevention of Venous Thromboembolism for Ambulatory Patients with Cancer (PREVenT-APC)

项目摘要 背景：静脉血栓栓塞（VTE）是癌症最常见的死亡原因之一 患者指南建议使用VTE风险分层来识别患有以下疾病的非卧床患者： 可能受益于预防性一级VTE预防的VTE高危癌症患者 抗凝然而，我们的初步数据表明，静脉血栓栓塞风险评估和主要 预防措施基本上没有得到充分利用。 目的和方法：本项目的总体目标是制定一个可行的，有效的， 可持续实施战略，以促进将循证医学纳入临床实践 癌症患者静脉血栓栓塞预防指南。该提案的具体目标是： 目标1：开展形成性研究，以制定执行战略（PREVent-APC） 促进在临床实践中采用指南推荐的基于风险的方法 对非卧床癌症患者进行一级静脉血栓栓塞预防; 目的2：使用随机试验，评估改进的PREVent-APC策略的有效性， 与常规治疗相比，对于已确定的高风险患者， 癌症患者;以及 目标3：探索实施结果和与变异性相关的背景因素， PREVent-APC实施的采用、忠实性、有效性和可接受性 战略 为了进行这项研究，我将制定预防-APC策略，并进行可用性测试，以完善 策略（目标1）;通过随机试验测试PREVent-APC策略（目标2）;以及，使用混合 方法，评估其他实施成果，并探讨 预防APC战略（目标3）。 职业发展和未来的工作：通过K23指导职业生涯的目标 发展奖，我将获得先进的知识和应用混合方法研究的技能， 行为干预临床试验设计，传播和实施科学，这将 进一步我的目标是成为一个独立的医生科学家与专业知识的发展， 实施和评估策略，以改善跨专业血液学护理。研究结果 将作为未来R级提案的基础，以调整和测试 不同环境下的预防艾滋病毒/艾滋病方案执行战略。最终， 拟议的研究是减少静脉血栓栓塞和改善癌症患者的预后。

PROJECT SUMMARY Background: Venous thromboembolism (VTE) is one of the most common causes of death in cancer patients. Guidelines recommend the use of VTE risk-stratification to identify ambulatory patients with cancer at high-risk of VTE who may benefit from primary VTE prevention with prophylactic anticoagulation. However, our preliminary data suggest that VTE risk assessment and primary prophylaxis are substantially underused. Aims and Methods: The overall objective of this project is to develop a feasible, effective, and sustainable implementation strategy to promote the uptake into clinical practice of evidence-based guidelines for VTE prevention in patients with cancer. The Specific Aims of this proposal are to: Aim 1: Conduct formative research to develop an implementation strategy (PREVenT-APC) promoting the uptake in clinical practice of a guideline-recommended, risk-based approach to primary VTE prevention for ambulatory patients with cancer; Aim 2: Using a randomized trial, assess effectiveness of the refined PREVenT-APC strategy as compared with usual care, to start and maintain thromboprophylaxis for identified high-risk patients with cancer; and Aim 3: Explore implementation outcomes and the contextual factors associated with variability in adoption, fidelity, effectiveness, and acceptability of the PREVenT-APC implementation strategy. To carry out the study, I will develop the PREVenT-APC strategy and conduct usability testing to refine the strategy (Aim 1); test the PREVenT-APC strategy via a randomized trial (Aim 2); and, using mixed methods, evaluate additional implementation outcomes, and explore variability in outcomes of the PREVenT-APC strategy (Aim 3). Career Development and Future Work: Through the objectives of the K23 Mentored Career Development Award, I will acquire advanced knowledge and apply skills in mixed method research, behavioral intervention clinical trial design, and dissemination and implementation science, which will further my goal of becoming an independent physician scientist with expertise in developing, implementing, and evaluating strategies to improve cross-specialty hematology care. The study findings will serve as a foundation for future R-level proposals to tailor and test adaptations and dissemination of the PREVenT-APC implementation strategy in different settings. Ultimately, the long-term goal of the proposed research is to reduce VTE and improve outcomes for patients with cancer.