A lack of understanding of primary care practice has limited previous efforts to enhance delivery of cancer early detection and prevention services. As an NCI-funded independent investigator, the applicant has developed innovative new approaches to understanding and enhancing cancer prevention and control in community primary care practice. Moreover, an Associate Director for Prevention, Control and Population Research at an NCI-designated Comprehensive Cancer Center, and as a director of one of 3 newly-funded family practice research centers, he has established mentoring relationships with junior investigators studying patient-oriented approaches to advancing the cancer prevention and control effectiveness of primary care practice. The proposed Midcareer Investigator Award in Patient-Oriented Research will use a multi-method research approach to advance cancer prevention and control in community primary care practice in 4 ways: 1) Expanded analysis of a rich existing dataset generated from the NCI-funded Direct Observation of Primary Care Practice (DOPC) Study, guided by a new theoretical model, will provide insights into previously unanticipated factors affecting cancer preventive service delivery in real world practice. 2) Collection and analysis of new data on high performing practices in the ongoing Study to Enhance Prevention by Understanding Practice (STEP- UP) will identify will identify practices' values, structures and processes that affect response to a prevention intervention. 3) These new data collection and analyses will be used to identify new intervention approaches to increase cancer investigators to develop innovative new interventions that integrate patient-oriented cancer screening, health habit counseling, familial risk identification and selective cancer genetic screening, and integration of population and clinical approaches to cancer prevention and early detection in primary care practice. This proposal builds on a strong set of ongoing investigations and investigators to create a critical mass of patient-oriented researchers. The innovative insights that are likely to spring from this initiative will advance the knowledge base for achieving the vas potential of primary care practice for cancer prevention and control.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Application #
Study Section
Subcommittee G - Education (NCI)
Program Officer
Gorelic, Lester S
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Fiscal Year
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Case Western Reserve University
Family Medicine
Schools of Medicine
United States
Zip Code
Goodwin, Meredith A; Stange, Kurt C; Zyzanski, Stephen J et al. (2017) The Hawthorne effect in direct observation research with physicians and patients. J Eval Clin Pract 23:1322-1328
Flocke, Susan A; Crabtree, Benjamin F; Stange, Kurt C (2007) Clinician reflections on promotion of healthy behaviors in primary care practice. Health Policy 84:277-83
Ruhe, Mary C; Weyer, Sharon M; Zronek, Sue et al. (2005) Facilitating practice change: lessons from the STEP-UP clinical trial. Prev Med 40:729-34
Stroebel, Christine K; McDaniel Jr, Reuben R; Crabtree, Benjamin F et al. (2005) How complexity science can inform a reflective process for improvement in primary care practices. Jt Comm J Qual Patient Saf 31:438-46
Acheson, Louise S; Stange, Kurt C; Zyzanski, Stephen (2005) Clinical genetics issues encountered by family physicians. Genet Med 7:501-8
Gilchrist, Valerie J; Stange, Kurt C; Flocke, Susan A et al. (2004) A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Med Care 42:276-80
Mainous 3rd, Arch G; Goodwin, Meredith A; Stange, Kurt C (2004) Patient-physician shared experiences and value patients place on continuity of care. Ann Fam Med 2:452-4
Flocke, Susan A; Stange, Kurt C (2004) Direct observation and patient recall of health behavior advice. Prev Med 38:343-9
Stange, Kurt C; Goodwin, Meredith A; Zyzanski, Stephen J et al. (2003) Sustainability of a practice-individualized preventive service delivery intervention. Am J Prev Med 25:296-300
Yawn, Barbara; Goodwin, Meredith A; Zyzanski, Stephen J et al. (2003) Time use during acute and chronic illness visits to a family physician. Fam Pract 20:474-7

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