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

项目总结 背景：静脉血栓栓塞症(VTE)是癌症最常见的死亡原因之一 病人。指南建议使用静脉血栓栓塞术风险分层来识别门诊患者 癌症是VTE的高危人群，他们可能受益于预防VTE的一级预防 抗凝剂。然而，我们的初步数据表明，VTE风险评估和初级 预防措施在很大程度上没有得到充分利用。 目标和方法：本项目的总体目标是开发一种可行、有效和 促进循证医学进入临床实践的可持续实施策略 癌症患者静脉血栓栓塞术预防指南。这项建议的具体目的是： 目标1：进行形成性研究以制定实施战略(预防-APC) 促进在临床实践中采用指南推荐的、基于风险的方法 为门诊癌症患者提供初级VTE预防； 目的2：使用随机试验，评估改进的预防-APC策略的有效性 与常规护理相比，对已确定的高危人群开始并维持血栓预防措施 癌症患者；以及 目标3：探讨执行成果和与变异性有关的背景因素 预防-APC实施的采用率、保真度、有效性和可接受性 策略。 为了进行这项研究，我将开发预防-APC策略并进行可用性测试以改进 战略(目标1)；通过随机试验测试预防--APC战略(目标2)；以及使用混合 方法，评估额外的执行成果，并探索成果的可变性 预防--APC战略(目标3)。 职业发展和未来工作：通过K23职业指导生涯的目标 获得发展奖后，我将在混合方法研究中获得先进的知识和应用技能， 行为干预临床试验设计，以及传播和实施科学，这将 进一步推进我的目标，成为一名独立的内科科学家，拥有开发的专业知识， 实施和评估改善跨专科血液病护理的策略。研究发现 将作为未来R级提案的基础，以定制和测试改编和传播 不同环境下预防APC的实施策略。归根结底， 拟议的研究是为了减少VTE并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.