ActivityChoice: A clinic-delivered implementation program to increase physical activity and decrease cardiovascular disease risk amongst cancer survivors

ActivityChoice：临床实施计划，旨在增加癌症幸存者的体力活动并降低心血管疾病风险

• 批准号: 10588798
• 负责人: Jamie Faro
• 金额: $ 16.25万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-13 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588798
• 关键词: Address; Adoption; Aftercare; American Heart Association; COVID-19; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Caring; Cause of Death; Clinic; Clinical; Collaborations; Communities; Computerized Medical Record; Data; Decision Aid; Development; Effectiveness; Electronics; Enrollment; Evidence based program; Feedback; Future; General Population; Grant; Health; Hearing; Institute of Medicine (U.S.); Institution; Intervention; Interview; Leadership; Letters; Light; Malignant Neoplasms; Mentored Clinical Scientist Development Program; Mentors; Monitor; Outcome; Paper; Participant; Pathway interactions; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Persons; Physical activity; Practical Robust Implementation and Sustainability Model; Pragmatic clinical trial; Process; Protocols documentation; Provider; Recommendation; Regulation; Reporting; Research Personnel; Resources; Risk; Risk Factors; Risk Reduction; Role playing therapy; Secure; Self Determination; Site; Surveys; Survivors; System; Testing; Time; Training; Uncertainty; United States; Visit; Walking; Work; cancer diagnosis; cardiovascular disorder risk; clinical implementation; design; digital health; digital monitoring; evidence base; experience; fitbit; flyer; follow-up; health related quality of life; implementation outcomes; meetings; mortality; multi-site trial; novel; patient engagement; patient oriented; patient-clinician communication; physical conditioning; pilot test; pragmatic trial; prevent; programs; randomized trial; sedentary; shared decision making; skills; stakeholder perspectives; standard of care; support tools; survivorship; tailored messaging; theories; tool; virtual group

PROJECT SUMMARY Cancer survivors have 1.7-18.5-fold increased risk, and 1.3-3.6-fold increased mortality of cardiovascular disease (CVD). Physical activity has been shown to ameliorate risk, but survivors’ levels are far below the general population. Due to this, provider physical activity recommendations and referrals are recommended by the Institute of Medicine and the American Heart Association in survivorship care plans. In light of these recommendations, barriers to physical activity participation among survivors exist at the provider, community, and survivor levels. There is a critical need for implementation programs to connect these resources to increase physical activity among survivors. To address this need, I developed, and beta tested a clinic-based eReferral system referring patients to a nationwide community-based group program, LIVESTRONG at the Y, for survivors. Due to COVID-19, we also referred to a virtual group program, Fit Cancer. The beta-test revealed the potential of this approach; providers were engaged and referred survivors to the physical activity programs. It also revealed the need for the eReferral to provide physical activity program choices, including a non-group self- monitored digital health program. We, therefore, will build on the prior eReferral to develop and test ActivityChoice in this 4-year proposal. ActivityChoice will include a patient narrative decision aid to support choices to three evidence-based programs: LIVESTRONG (group in-person), Fit Cancer (group virtual), and CareEvolution (Fitbit activity tracking and tailored messaging digital health). We found survivors prefer to hear personal stories and support from other survivors to help support activity adoption, thus our decision aid will include patient narrative stories to support program choices. In Aim 1, we will develop and test patient decision aids to support choices with survivors and clinic staff and refine ActivityChoice. In Aim 2, we will conduct a stepped wedge trial with clinic staff (n=8) at 3 UMass Cancer clinics sites, comparing an enhanced standard of care control to the ActivityChoice implementation program in 70 patients with survivorship care planning visits. We hypothesize ActivityChoice will have greater referral rates as compared to the enhanced standard of care control. We will assess additional implementation outcomes, as well as exploratory physical activity and patient- reported outcomes. In Aim 3, we will refine ActivityChoice and prepare for a multi-site trial through interviews with stakeholders (survivors, clinic staff and administration) and potential future sites identified through our collaborative networks. The refined program will be tested in a fully-powered effectiveness R01 trial submitted in Year 4 of this project. To accomplish these aims, I will be guided by expert mentors and receive specialized training in 1) Health and patient-provider communication, 2) Digital Health, 3) Advanced pragmatic clinical trials and 4) Leadership and grant-development. This project will be conducted in collaboration with our clinical, community and patient partners (Community Advisory Board) to guide the overall project design.

项目总结 癌症幸存者的风险增加1.7-18.5倍，心血管疾病死亡率增加1.3-3.6倍 疾病(CVD)。体力活动已被证明可以降低风险，但幸存者的水平远远低于一般水平 人口。由于这一点，提供者体力活动建议和推荐由 医学研究所和美国心脏协会的生存护理计划。鉴于这些， 建议，幸存者参与体育活动的障碍存在于提供者、社区、 和幸存者级别。迫切需要实施方案将这些资源连接起来，以增加 幸存者的体力活动。为了满足这一需求，我开发了一个基于诊所的eReferral，并进行了Beta测试 该系统将患者转介到一个全国性的以社区为基础的团体计划，为幸存者提供Livestrong at the Y。 由于新冠肺炎的缘故，我们还提到了一个名为Fit癌症的虚拟团体项目。贝塔测试揭示了这一潜力 对于这种方法，提供者参与并推荐幸存者参加体力活动计划。它还 揭示了eReferral提供体力活动计划选择的必要性，包括非团体自我 监控数字健康计划。因此，我们将在以前的电子推荐的基础上进行开发和测试 练习在这份为期4年的计划书中选择。ActivityChoice将包括患者叙事决策辅助以支持 三个循证计划的选择：Livestrong(面对面小组)、Fit癌症(小组虚拟)和 CareEvolution(Fitbit活动跟踪和定制消息数字健康)。我们发现幸存者更愿意听到 个人故事和其他幸存者的支持，以帮助支持活动的采用，因此我们的决策援助将 包括耐心的叙事故事，以支持节目选择。在目标1中，我们将开发和测试患者的决策 艾滋病支持幸存者和诊所工作人员的选择，并改进活动选择。在目标2中，我们将进行 在3个加州大学马萨诸塞州癌症诊所地点与诊所工作人员(n=8)进行阶梯式楔形试验，比较增强的标准 对70例接受生存护理计划访问的患者实施ActivityChoice计划的护理控制。 我们假设，与增强的护理标准相比，ActivityChoice将有更高的转诊率 控制力。我们将评估其他实施成果，以及探索性体力活动和患者- 报告结果。在目标3中，我们将完善ActivityChoice，并通过面试为多地点试验做准备 与利益相关者(幸存者、诊所工作人员和管理层)和潜在的未来地点通过我们的 协作网络。改进后的计划将在提交的全功率有效性R01试验中进行测试 在这个项目的第四年。为了实现这些目标，我将在专家导师的指导下，获得专门的 培训1)健康和患者-提供者沟通，2)数字健康，3)高级实用临床试验 (4)领导力和赠款开发。这个项目将与我们的临床， 社区和患者合作伙伴(社区咨询委员会)指导整个项目设计。