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职业发展计划的总体目标是促进Erin Gillespie博士 发展成为癌症卫生服务研究的独立研究者，重点是 增强辐射肿瘤学的质量和基于证据的护理。该提议的重点是缩短 从7-9周到3-5周的辐射过程（称为“低摘要”） 等效的癌症控制，改善患者报告的结局以及乳房患者的成本提高 和前列腺癌。但是，采用速度很慢。吉莱斯皮博士的先前工作表明 个体辐射肿瘤学家在乳腺癌患者是否接受 降压或更长的辐射过程。 总体假设是放射肿瘤学家是放射治疗决策中的关键 制定以及实施策略，即利用行为经济学最有可能影响 练习改变。我的主要目标是1）识别和表征积极的偏射肿瘤学家 （高剥夺的高用户）将2）阐明实施策略并将其关联 在各种环境中采用低剥夺，3）试验测试一种促进的多管齐下策略 使用次级化的使用来准备大型务实的多中心对照试验。理由 拟议的研究和培训计划的基础是，有了有关驱动器杠杆的新知识 身体决策（超出知识差距），医疗保健领导者和政策制定者可以最佳 唤起变化的设计和实施系统。吉莱斯皮博士将利用 纪念斯隆·克特林癌症中心，她是辐射部的教职员工 肿瘤学和卫生政策与成果中心。她还从事社区研究 - 通过MSK癌症联盟进行设置。她的培训计划是实施科学的基础 结合了大型数据集分析，混合方法和行为经济理论。 在拟议的研究的AIM 1中，研究人员将分析包括索赔的Medicare数据集 与开处方肿瘤学家和组织有关，并由AMA Masterfile补充。他们 将系统地进行对辐射肿瘤中实施策略的首次评估 混合方法。最后，在AIM 3中，调查人员将开发和试点测试一项多管齐下的策略 通过目标1-2，包括审核和反馈。该建议以及吉莱斯皮博士的新技能将 获取，将产生有关实施策略对去实施的影响的新知识 长途辐射 - 设计最佳策略所需的关键参数，以鼓励医生 采用高价值辐射。这将特别支持制定实施策略 在随后的前瞻性随机试验中进行测试，以评估现实世界效率。