NCI ESSP: An Equity Focused Intervention to Improve Utilization in Guideline Concordant Extended Venous Thromboembolism Prophylaxis After Major Cancer Surgery

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Project Summary/Abstract Venous thromboembolism (VTE) following major cancer surgery is a significant contributor to morbidity and mortality. Extended VTE prophylaxis (ePpx) following major cancer surgery decreases the risk of post-hospital VTE and is recommended by professional societies. However, utilization of ePpx remains limited. Moreover, racial disparities exist for cancer associated outcomes including VTE and mortality. These inequities in broader cancer care suggest that disparities may exist related to the utilization of ePpx. This aspect of cancer care has not been studied through a lens of cancer health disparities. The reasons for low utilization of ePpx remain a significant knowledge gap. Electronic medical record (EMR)-based clinical decision support systems (CDSS) have been effective in improving adherence to inpatient VTE prophylaxis though has not been studied for ePpx. The overall objective of this work is to identify barriers and facilitators related to ePpx guideline adherence and convene stakeholders to develop and implement a multi-faceted educational intervention including an EMR- based CDSS for increasing guideline adherence in a diverse oncology population. Our central hypothesis is that modifiable patient and surgeon factors exist, which provide an explanatory mechanism for poor adherence to ePpx guidelines (both by the surgeon and patient) and that these factors may be overcome by the equity focused intervention described below. We will test our hypotheses through these specific aims: Specific Aim 1: Characterize barriers and facilitators to ePpx guideline adherence as perceived by stakeholders via key informant interviews with a diverse group of patients and surgeons at three hospitals within the MUSC Health system that routinely perform abdominopelvic cancer surgery. Hypothesis 1: Barriers and facilitators related to ePpx use exist that are not forthcoming from clinical data; once uncovered, these factors will inform the educational interventions in Aims 2.1 and 2.2. Specific Aim 2.1: Conduct a stepped-wedge randomized trial including multi-faceted surgeon-focused education and academic detailing to evaluate the impact of an EMR-based CDSS to increase adherence to ePpx guidelines at the three selected hospitals. Hypothesis 2.1: The intervention will increase ePpx following abdominopelvic cancer surgery. Specific Aim 2.2: Evaluate the impact of VTE related pre-discharge education on patient adherence to ePpx via a pre-post study of patients undergoing abdominopelvic cancer surgery at the three selected hospitals. Hypothesis 2.2: Focused VTE related education will improve patient adherence. The application of rigorous qualitative research methodology to this clinical context will elucidate mechanisms to improve administration of guideline concordant ePpx. Pairing these data with a multi-faceted, stakeholder informed educational intervention, this work has the potential to significantly impact cancer care and mitigate cancer health disparities.