Cancer survivors face unique challenges and have special medical needs as a result of their cancer diagnosis and treatment. Recent evidence suggests that these needs are often not currently being met, in part because as patients move beyond needing to be cared for by their oncologist they find that their primary care providers are not adequately trained to anticipate and treat the medical complications of their treatment. The purpose of this project is to address that need through development and implementation of a curriculum to teach primary care physicians in rural medical practices in Colorado about the special medical needs of cancer survivors and to empower them to identify cancer survivors in their practice and to implement survivorship care planning for them. This goal will be achieved through engagement of physicians, nurses, physician assistants, and office staff within their own practice setting as well as members of the local community. During the first year of the project, a Scientific Advisory Board and a Community Advisory Board will work together to provide feedback and direction to the project's Cancer Survivorship Curriculum. The curriculum will focus on cancer care planning using the recommendations of the Institute of Medicine for cancer survivorship and be translated into an easily implementable way for primary care practitioners and their office staff. Fifty-four practices will be recruited to participate and the be randomized to one of two groups: an Intervention Group versus a Comparison Group that will serve as a control group. This multi-faceted curriculum will incorporate several complementary educational methods, including: (1) four in-person individualized interprofessional small group discussions within the practice settings;(2) a series of 12 Webinars delivered annually by experts in the field;(3) a content-rich website;and (4) password-protected moderated discussion forums. The practice visits will occur during the second through fifth years of the grant period. Additionally, study participants will be provided with a Cancer Survivorship Toolkit developed as part of this project that includes evidence-based guidelines to care for cancer survivors. The effectiveness of the curriculum will be evaluated by assessing changes in participants'knowledge as a result of exposure to the curriculum. Adoption of the curricular content into the practice setting will be measured using chart reviews of survivors of cancers targeted as part of the Project (i.e., breast, colon, prostate, and any childhood cancer). This project is innovative in a number of ways: (1) it provides a mechanism for cancer survivors to have their medical needs met within their medical home;(2) it engages primary care physicians by bringing the curriculum directly to their practice setting;(3) it engages not only the physicia, but all members of the practice;(4) it involves not only experts in treatment and survivorship in development and refinement of the curriculum, but also people with knowledge of rural primary care practices and the communities in which they practice, increasing the likelihood that the information being taught will be implemented;and (5) it uses a randomized control trial design for an educational intervention.
Improved cancer screening, diagnosis and treatment over the last half-century have resulted in improved cancer survival but cancer treatments can also lead to serious late and long-term effects that cause significant morbidity. Most cancer survivors receive their follow-up care in community health settings and need health care providers knowledgeable about the late effects of cancer and that understand their unique medical needs. The Cancer Survivorship Curriculum that we are proposing will fill a critical need to enhance the capacity of primary care practices to care for individuals with a history of cancer, especially in rural areas where an educated primary care workforce is essential to the health of local communities.
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