Implementing Palliative Care: Learning Collaborative vs. Technical Assistance

实施姑息治疗：学习协作与技术援助

• 批准号: 10571862
• 负责人: Lisa Zubkoff
• 金额: --
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-08 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10571862
• 关键词: Address; Adopted; Adoption; Advanced Malignant Neoplasm; Alabama; American Cancer Society; American Society of Clinical Oncology; Cancer Center; Cancer Patient; Caregivers; Caring; Client; Clinic; Clinical; Cluster randomized trial; Community Clinical Oncology Program; Data Reporting; Diagnosis; Disseminated Malignant Neoplasm; E-learning; Effectiveness; Evidence based practice; Feedback; Funding; Goals; Guidelines; Health system; Healthcare; Healthcare Systems; Hybrids; Knowledge; Learning; Life; Measures; Methods; Minority; Modeling; Moods; National Cancer Institute; Newly Diagnosed; Oncology; Online Systems; Outcome; Palliative Care; Patient-Focused Outcomes; Patients; Population; Problem Solving; Procedures; Proctor framework; Public Health; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reproducibility; Research; Research Design; Research Institute; Rural; Services; South Carolina; Symptoms; Testing; Training; Work; cancer care; care systems; cluster randomized design; comparative trial; compare effectiveness; disparity reduction; effective therapy; effectiveness evaluation; effectiveness testing; effectiveness/implementation design; effectiveness/implementation trial; evidence base; health care availability; implementation barriers; implementation outcomes; implementation process; implementation research; implementation strategy; implementation trial; improved; improved outcome; intervention program; programs; response; rural dwellers; success; telehealth; treatment planning; uptake; virtual

Project Summary    The American Society of Clinical Oncology (ASCO) recommends “…combined standard oncology care and  palliative care…early in the course of illness for any patient with metastatic cancer and/or high symptom  burden”. Unfortunately, early palliative care is not routinely incorporated into treatment plans at the onset of  advanced diagnosis, thereby depriving patients of potential quality of life benefits, especially low access  populations including minorities and rural-­dwellers. The problem is that we do not know how to best assist  health systems wanting to integrate early palliative care services into their usual oncology care. Virtual  Learning Collaboratives (VLCs), comprised of multiple health systems that work together virtually to implement  an evidence-­based practice, offer a solution. VLC features include the formation of quality improvement teams,  group problem solving, and data reporting/feedback. Despite widespread use of VLCs in healthcare, few  studies have evaluated their effectiveness. To address this gap, we propose to test the effectiveness of a VLC  implementation strategy on integration of an evidenced-­based model of early concurrent oncology palliative  care called ENABLE (Educate, Nurture, Advise, Before Life Ends). ENABLE is the only evidence-­based,  scalable early palliative care model promoted by the National Cancer Institute (NCI) Research Tested  Intervention Program. Guided by the RE-­AIM framework and using Proctor’s Outcomes for Implementation  Research model, we propose a cluster-­randomized trial with 48 NCI Community Oncology Research Program  (NCORP) practices implementing ENABLE to evaluate the effectiveness of a Virtual Learning Collaborative  (VLC) compared to typical implementation consisting of limited technical assistance (TA). In this hybrid type III  design implementation effectiveness trial, we will compare two implementation strategies in real world  oncology practices to determine Implementation (ENABLE uptake), Service, and Patient outcomes. Study aims  are: 1) Compare the effectiveness of VLC vs. TA on ENABLE program uptake, measured as the proportion of  patients at participating NCORP practices who complete the ENABLE program;? 2) Compare the effectiveness  of VLC vs. TA on NCORP practices implementation teams’ fidelity to ENABLE and assigned implementation  strategy;? 3) Compare NCORP practices randomized to VLC or TA on patient and caregiver quality of life (QOL)  and mood outcomes;? and 4) Determine the relationship between ENABLE program uptake and fidelity and  patients’ QOL and mood across the two strategies. This research will impact public health by addressing a  knowledge gap on appropriate strategies to implement scalable evidence-­based palliative care practices while  reducing the disparity of sub-­optimal cancer care for advanced cancer patients.

项目总结