Pragmatic Implementation Science Approaches to Assess and Enhance Value of Cancer Prevention and Control in Rural Primary Care

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Project Summary/Abstract – Research Program The theme of our proposed Implementation Science Center is “Pragmatic implementation science approaches to assess and enhance the value of cancer prevention and control in rural primary care.” We will apply and advance frameworks, pragmatic methods, and measures related to cost, benefits, and value that are rigorous, but also generalizable across rural primary care settings that are often struggling with low resources, and a high need population. These models and methods will be used to guide selection and implementation of evidence-based programs for cancer prevention and control (CPC). We will initially focus on lung cancer screening in rural primary care settings, first in Colorado and then nationally through collaboration with a well- established primary care network (i.e., National Research Network). Our overarching framework will be our enhanced RE-AIM/PRISM model, which is an extension of the broadly used Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with the addition of contextual factors (e.g., Intervention characteristics, implementation and sustainability infrastructure). It will serve as the basis to develop and test innovative assessments of costs, benefits, and value from the perspective of different stakeholders to understand and guide implementation. We will meaningfully engage with and include the perspectives of patients, providers, and staff stakeholders in all our studies. Our pilot Implementation Study will adapt, implement, and evaluate strategies using stakeholder-engaged approaches to value to guide the implementation of shared decision-making and smoking cessation related to lung cancer screening. Our Methods Unit will refine and evaluate our pragmatic cost assessment methods to determine implementation/replication costs from the perspective(s) of patients, providers, and delivery staff and then develop and pilot test brief survey measures of preferences regarding the relative benefit of different RE-AIM outcomes. We will then assess relationships among RE-AIM outcomes preferences and selection of different CPC programs. Finally, our Outreach and Network Unit will engage in a) outreach activities targeted at junior and mid-career investigators and practitioners including online professional development (e.g., graduate certificate program, micro-certification) and tailored mentoring and technical assistance approaches; b) dissemination activities to support the packaging and communication of research findings; and c) collaboration activities to facilitate partnerships on CPC and implementation science using multiple channels and including development of shared pragmatic D&I measures and data.