Adapting and implementing evidence-based breast cancer follow-up in primary care

项目概要/摘要 乳腺癌幸存者是一个不断增长的人口，他们的症状负担是显着的。尽管越来越多 关于具体症状和风险管理战略的证据，将知识转化为实践的努力 产生了不理想的结果。初级保健是乳腺癌幸存者的理想受体部位， 研究证明了基于初级保健的生存护理的有效性。然而，在过去， 十年来，对生存护理计划和生存模式的重视并没有对 初级保健乳腺癌生存护理过程。在过去的二十年里，初级保健实践 重新设计了结构和护理流程，为不同的复杂人群提供护理;然而， 乳腺癌幸存者不在其中。许多目前提出和测试的战略被认为是 以肿瘤学为中心，并且不适合初级保健实践的真实的世界背景。源自我们的 最近的研究表明，乳腺癌的生存率在临床上是不可行的， 在初级保健实践与先进的人员配置模式。因此，能力建设和利益攸关方- 需要采取明智的策略，以提高生存证据转化为主要证据的潜力。 护理实践。该项目采用"为传播而设计"的观点， 探索、规划、实施和维持（EPIS）框架和初级保健实践 变革模型（PCM）作为理解影响实施的多层次因素的理论基础 癌症存活率指南。这些视角有助于构建和识别不匹配 在现有的政策，实践，提供者和患者激励因素中， 可操作的初级保健实践改变战略。使用混合实施/初级保健实践 改变概念框架，该项目旨在：（1）让不同的初级保健利益攸关方参与确定 在初级保健中提供长期乳腺癌生存护理的可行的、基于实践的活动 使用深度访谈;（2）优先考虑，综合，并确定为长期提供护理的可行活动- 通过使用修改后的在线德尔菲方法与关键利益相关者接触， 概念图;（3）实施和评估可行的乳腺癌生存症状和风险 管理活动使用混合类型1有效性-实施集群研究设计与等待名单 在26个初级保健实践中进行控制。研究结果有望对实施产生深远影响 在美国各地使用的策略，为有乳腺癌病史的患者提供长期护理。

PROJECT SUMMARY/ABSTRACT Breast cancer survivors are a growing population and their symptom burden is significant. Despite growing evidence on specific symptoms and risk management strategies, efforts to translate knowledge into practice have produced suboptimal results. Primary care is an ideal receptor site for breast cancer survivors, with studies demonstrating the effectiveness of primary care based survivorship care. Nevertheless, over the past decade, the emphasis on survivorship care plans and survivorship models has not had an evident impact on primary care breast cancer survivorship care processes. Over the past two decades, primary care practices have redesigned structures and care processes to deliver care to different complex populations; however, breast cancer survivors are not among them. Many currently proposed and tested strategies are considered oncology-centric and do not fit well within the real world contexts of primary care practices. Results from our recent research studies indicate that breast cancer survivorship is not considered clinically actionable even among primary care practices with advanced staffing models. Therefore, capacity building and stakeholder- informed strategies are needed to enhance the translational potential of survivorship evidence into primary care practices. This project uses a “designing for dissemination” perspective, blending the implementation Exploration, Planning, Implementation and Sustainment (EPIS) framework and the primary care Practice Change Model (PCM) as a theoretical basis for understanding multilevel factors impacting the implementation of cancer survivorship guidelines in primary care. These perspectives help frame and identify mismatches among existing policy, practice, provider, and patient motivators to translate the evidence into clinically actionable primary care practice change strategies. Using a blended implementation/primary care practice change conceptual framework, this project aims to: (1) engage diverse primary care stakeholders in identifying actionable, practice-based activities for provision of long-term breast cancer survivorship care in primary care using depth interviews; (2) prioritize, synthesize, and identify actionable activities for providing care to long- term cancer survivors in primary care by engaging key stakeholders using modified online Delphi methods and concept mapping; and (3) implement and evaluate actionable breast cancer survivorship symptom and risk management activities using a hybrid type 1 effectiveness-implementation cluster study design with waitlist control in 26 primary care practices. Study results are poised to have profound impact on implementation strategies used throughout the U.S. to provide long-term care for patients with a history of breast cancer.