Leveraging implementation science to accelerate adoption of shorter-course radiation for breast and prostate cancer

利用实施科学加速乳腺癌和前列腺癌短程放疗的采用

• 批准号: 10239071
• 负责人: Erin Faye Gillespie
• 金额: $ 26.3万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10239071
• 关键词: Address; Adopted; Adoption; Atlas of Cancer Mortality in the United States; Cancer Burden; Cancer Control; Caring; Clinical Pathways; Communities; Coupled; Data Set; Decision Making; Deimplementation; Development; Evidence based practice; Faculty; Feedback; Foundations; Funding; Goals; Guidelines; Health Policy; Health Services Research; Healthcare; Hospitals; Human; Improve Access; Incentives; Individual; Influentials; Knowledge; Leadership; Link; Malignant Neoplasms; Malignant neoplasm of prostate; Medicare; Memorial Sloan-Kettering Cancer Center; Mentors; Mentorship; Methodology; Methods; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Peer Review; Performance; Physicians; Population Study; Preparation; Prostate; Public Health; Publications; Publishing; Quality of life; Radiation; Radiation Oncologist; Radiation Oncology; Radiation therapy; Randomized Clinical Trials; Reporting; Research; Research Personnel; Research Proposals; Research Training; Resources; Scientist; System; Taxes; Testing; Training; Translating; United States; United States National Institutes of Health; Variant; Work; base; behavioral economics; cancer care; cancer therapy; career development; clinical practice; cost; density; design; deviant; evidence base; experience; implementation evaluation; implementation science; implementation strategy; improved; insight; large datasets; malignant breast neoplasm; member; patient oriented; practice setting; prospective; randomized trial; skills; social; theories; uptake

PROJECT SUMMARY/ABSTRACT The overall goal of this NCI K08 career development proposal is to facilitate Dr. Erin Gillespie’s development into an independent investigator in cancer health services research focusing on strategies to enhance quality and evidence-based care in radiation oncology. This proposal focuses on shortening the course of radiation from 7-9 weeks to 3-5 weeks (called “hypofractionation”) which is associated with equivalent cancer control, improved patient-reported outcomes, and decreased costs in patients with breast and prostate cancer. Nonetheless, adoption has been slow. Dr. Gillespie’s prior work has revealed that the individual radiation oncologist is highly influential in whether patients with breast cancer receive hypofractionation or a longer course of radiation. The overall hypothesis is that radiation oncologists are the linchpin in radiation treatment decision- making, and that implementation strategies that harness behavioral economics will be most likely to impact practice change. My primary objectives are to 1) identify and characterize positive deviant radiation oncologists (high users of hypofractionation) that will 2) elucidate implementation strategies and associate them with adoption of hypofractionation across various settings, and 3) pilot test a multi-pronged strategy that promotes use of hypofractionation in preparation for a large pragmatic multi-center controlled trial. The rationale that underlies the proposed research and training plan is that, with new knowledge about the levers that drive physician decision-making (beyond knowledge gaps), healthcare leaders and policymakers can optimally design and implement systems that evoke change. Dr. Gillespie will harness the resources and expertise at Memorial Sloan Kettering Cancer Center, where she is a faculty member in the Department of Radiation Oncology and the Center for Health Policy and Outcomes. She is also engaged in research in the community- based setting through the MSK Cancer Alliance. Her training plan has a foundation of implementation science that incorporates large dataset analysis, mixed methods, and behavioral economic theory. In Aim 1 of the proposed study, the investigators will analyze a Medicare dataset that includes claims linked to prescribing radiation oncologist and organization, and is supplemented by the AMA Masterfile. They will systematically conduct the first-ever evaluation of implementation strategies in radiation oncology using mixed methods. Lastly, in Aim 3 the investigators will develop and pilot test a multi-pronged strategy informed by Aims 1-2 and including audit and feedback. This proposal, together with the new skills Dr. Gillespie will acquire, will generate new knowledge about the impact of implementation strategies on de-implementation of long-course radiation – key parameters necessary to design optimal strategies to encourage physicians to adopt high value radiation. This will specifically support the development of an implementation strategy that will be tested in a subsequent prospective randomized trial to assess real world efficacy.

项目摘要/摘要 NCI K08职业发展提案的总体目标是促进Erin Gillesbie博士的 发展成为癌症健康服务研究的独立调查者，专注于以下战略 提高放射肿瘤学的质量和循证护理。这项提案的重点是缩短 放射疗程从7-9周到3-5周(称为“低分馏”)，这与 同等的癌症控制，改善患者报告的结果，并降低乳腺癌患者的成本 和前列腺癌。尽管如此，人们对它的采用一直很缓慢。吉莱斯皮博士之前的工作揭示了 个人放射肿瘤学家对乳腺癌患者是否接受治疗有很大影响 低分馏或较长疗程的辐射。 总体假设是，放射肿瘤学家是放射治疗决策的关键-- 以及利用行为经济学的实施战略最有可能影响 实践改变。我的主要目标是：1)识别和描述阳性的异常放射肿瘤学家 (低分馏的高用户)将2)阐明实施战略并将其与 在各种环境中采用低分馏，以及3)试点测试多管齐下的战略，以促进 使用降分馏法准备一项大型、务实的多中心对照试验。其基本原理是 拟议的研究和培训计划的基础是，拥有关于驱动杠杆的新知识 医生决策(超越知识差距)，医疗保健领导者和政策制定者可以 设计和实施能够引发变革的系统。吉莱斯皮博士将利用资源和专业知识 纪念斯隆·凯特琳癌症中心，她是该中心放射科的教员 肿瘤学和卫生政策与结果中心。她还在社区中从事研究- 通过MSK癌症联盟的基础设置。她的培训计划有实施科学的基础 它融合了大数据集分析、混合方法和行为经济学理论。 在拟议研究的目标1中，调查人员将分析包括索赔在内的医疗保险数据集 链接到处方放射肿瘤学家和组织，并由美国医学会主文件补充。他们 将首次系统地评估放射肿瘤学的实施战略 混合方法。最后，在目标3中，调查人员将制定和试行多管齐下的战略。 目标1-2，包括审计和反馈。这项提议，连同吉莱斯皮博士将掌握的新技能 获得，将产生关于执行战略对取消执行的影响的新知识 长程放射-设计最佳策略所需的关键参数，以鼓励医生 采用高值辐射。这将具体支持制定一项执行战略， 在随后的前瞻性随机试验中进行测试，以评估现实世界的疗效。