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Dissemination and implementation of DIGEST™ as an evidence-based measurement tool for dysphagia in cancer

传播和实施 DIGEST™ 作为癌症吞咽困难的循证测量工具

基本信息

批准号：
10584824
负责人：
Katherine Arnold Hutcheson
金额：
$ 69.88万
依托单位：
UNIVERSITY OF TX MD ANDERSON CAN CTR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-15 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584824
关键词：
Address Adopted Adoption Adverse event Affect Agreement Aspiration Pneumonia Barium swallow Bolus Infusion Cancer Survivor Cancer Survivorship Caregivers Caring Cessation of life Characteristics Choking Clinic Clinical Clinical Practice Variations Clinical Trials Collection Common Terminology Criteria for Adverse Events Complement Consolidated Framework for Implementation Research Data Data Set Decision Trees Deglutition Deglutition Disorders Development Diagnostic Dissemination and Implementation Dose Eating Effectiveness Enteral Feeding Environment Esophagus Evaluation Evidence based practice Exercise Focus Groups Food Frequencies Fright Funding Goals Head and Neck Cancer Health Health system Healthcare Systems Image Individual Injury Institution International Knowledge Language Length of Stay Liquid substance Longevity Malignant Neoplasms Malnutrition Measurement Measures Medical Medical Care Costs Methodology Methods Muscle National Cancer Institute Oncology Outcome Outcome Measure Pathologist Patient-Focused Outcomes Pattern Penetration Pharyngeal structure Physiological Pneumonia Population Population Heterogeneity Prevalence Protocols documentation Psychometrics Publishing Quality of life Radiation Dose Unit Randomized Reporting Reproducibility Research Research Peer Review Research Personnel Resources Safety Services Severities Site Speech Structure Supportive care Surveys Time Toxic effect Training Programs Uncertainty United States Validation Work arm aspirate cancer care care outcomes clinical care clinical decision-making clinical practice contextual factors daily functioning design dietary restriction dissemination science effectiveness evaluation evidence base food preparation functional status implementation science implementation strategy improved mortality mortality risk personalized care programs radiological imaging research to practice response routine practice scale up secondary analysis tool uptake

项目摘要

ABSTRACT Dysphagia (difficulty swallowing) is a highly prevalent and impactful condition with significant burden on the healthcare system. Across the lifespan, dysphagia is associated with excess risk of mortality, increased length of stay, aspiration pneumonia, and malnutrition thereby elevating medical costs and resource utilization. Not only a health problem, dysphagia also adversely affects quality of life and daily function with disproportionate impact on cancer survivors. Adoption of evidence-based methods into clinical practice lags decades behind discovery. One such gap is adoption of evidence-based practices (EBP) by speech-language pathologists in dysphagia management. Evidence-based dysphagia care begins with evidence-based swallowing evaluation. Significant progress has been made in the field of dysphagia to develop evidence-based evaluation methods, with particular emphasis on physiologic characterization of swallowing. The relative safety and efficiency of swallowing, that is how well a food or liquid bolus is kept out of the airway and clears fully through the pharynx into the esophagus, is a fundamental driver of clinical decision making – yet, remains inconsistently assessed and reported in clinical practice. To address this gap, the investigators’ developed DIGEST™ (Dynamic Imaging Grade of Swallowing Toxicity). DIGEST is an EBP tool to grade the severity of pharyngeal dysphagia based on results of a radiographic (videofluoroscopic) modified barium swallow (MBS) study. DIGEST uses a basic flowsheet and rubric (available open access via PMC) to summarize the patterns of penetration/aspiration and pharyngeal residue observed on the MBS as markers of swallowing safety and efficiency. DIGEST is a pragmatic yet robust measure validated in the head and neck cancer population, and adopted into routine practice at the PI’s institution with over 11,000 MBS graded in the clinic using the methodology since development in 2016. Peer-reviewed research shows adoption of DIGEST in external academic medical settings and federally funded clinical trials. Despite this promise, several obstacles still limit widespread adoption in routine cancer care. These include scalability to fit diverse clinical contexts outside the PI’s environment and uncertainty about best implementation strategies. The long-term goal of this project is to improve dysphagia care and patient outcomes through reliable adoption of DIGEST into routine clinical practice. Our central hypothesis is that DIGEST scales-up maintaining validity in diverse cancer populations under common clinical practice variations with reliable adoption facilitated by an active implementation strategy. The objective of this application is to use dissemination and implementation (D&I) science to accomplish the following Specific Aims: 1) demonstrate validity of DIGEST in diverse oncology populations and imaging acquisition protocols, 2) examine context and fidelity of natural dissemination of DIGEST in real-world, early adopters, and 3) evaluate active implementation strategies to improve reach and fidelity of DIGEST in clinical practice. With dense multi-site networks and content expertise, the investigators are uniquely equipped to conduct the proposed D&I project. We expect this work to improve care by narrowing the research-to-practice gap in dysphagia diagnostics.

摘要