Implementation of Operative Standards in Cancer Surgery to Improve Patient Outcomes

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PROJECT SUMMARY The overall goal of this NCI K08 career development proposal is to facilitate Dr. Ko Un Park’s development into an independent investigator in cancer health services research focusing on implementation strategies that promote evidence-based care in surgical oncology and improve outcomes for cancer patients. Specifically, this proposal will apply insights from implementation science (IS) to the application of cancer surgery standards as set forth by the Commission on Cancer (CoC). The CoC is an accreditation organization that seeks to improve outcomes for individual patients with cancer through standardization of care delivery across 1500 hospitals providing care to some 70% of Americans with cancer. To date, the CoC has not paired its standards with implementation strategies; consequently, the standards’ implementation is often poor. The overarching goal of this project is to create stakeholder-driven strategies for adopting the use of the CoC’s new breast synoptic operative report (SOR) standard, by using tools from IS to identify and address barriers and facilitators to SOR implementation in diverse healthcare systems. To achieve this, in Aim 1 we will conduct key stakeholder interviews to identify barriers and facilitators to implementing breast SOR. In Aim 2, we will use evidence of implementation determinants to design strategies that facilitate breast SOR implementation. We will test the influence of the strategies on key implementation outcomes (e.g., feasibility, acceptability) in Aim 3. We hypothesize that we will identify both surgeon- and organization-level drivers of SOR implementation that can be leveraged to establish multi-level implementation strategies that will improve breast cancer outcomes. The planned training, proposed research project, multidisciplinary mentorship team, and exceptional research environment at The Ohio State University Comprehensive Cancer Center are ideally suited to address Dr. Park’s career goals. Her career development plan includes formal coursework in IS as well as directed readings and conferences. This education and mentored effort to execute the research proposal aid Dr. Park’s long-term career goal to become an independently funded implementation scientist-clinician to improve cancer patient outcomes by facilitating the implementation of professional self-regulation polices (i.e., CoC standards) in diverse health systems and cancer centers, and among physicians. With this training, Dr. Park will be able to successfully obtain funding for a subsequent prospective, multicenter trial testing the effectiveness of the strategies developed in the proposed project.