Abstract

TheAmericanSocietyofClinicalOncology(ASCO)recommends??combinedstandardoncologycareand palliativecare?earlyinthecourseofillnessforanypatientwithmetastaticcancerand/orhighsymptom burden?.Unfortunately,earlypalliativecareisnotroutinelyincorporatedintotreatmentplansattheonsetof advanceddiagnosis,therebydeprivingpatientsofpotentialqualityoflifebenefits,especiallylowaccess populationsincludingminoritiesandrural-dwellers.Theproblemisthatwedonotknowhowtobestassist healthsystemswantingtointegrateearlypalliativecareservicesintotheirusualoncologycare.Virtual LearningCollaboratives(VLCs),comprisedofmultiplehealthsystemsthatworktogethervirtuallytoimplement anevidence-basedpractice,offerasolution.VLCfeaturesincludetheformationofqualityimprovementteams, groupproblemsolving,anddatareporting/feedback.DespitewidespreaduseofVLCsinhealthcare,few studieshaveevaluatedtheireffectiveness.Toaddressthisgap,weproposetotesttheeffectivenessofaVLC implementationstrategyonintegrationofanevidenced-basedmodelofearlyconcurrentoncologypalliative carecalledENABLE(Educate,Nurture,Advise,BeforeLifeEnds).ENABLEistheonlyevidence-based, scalableearlypalliativecaremodelpromotedbytheNationalCancerInstitute(NCI)ResearchTested InterventionProgram.GuidedbytheRE-AIMframeworkandusingProctor?sOutcomesforImplementation Researchmodel,weproposeacluster-randomizedtrialwith48NCICommunityOncologyResearchProgram (NCORP)practicesimplementingENABLEtoevaluatetheeffectivenessofaVirtualLearningCollaborative (VLC)comparedtotypicalimplementationconsistingoflimitedtechnicalassistance(TA).InthishybridtypeIII designimplementationeffectivenesstrial,wewillcomparetwoimplementationstrategiesinrealworld oncologypracticestodetermineImplementation(ENABLEuptake),Service,andPatientoutcomes.
Study aims are:1)ComparetheeffectivenessofVLCvs.TAonENABLEprogramuptake,measuredastheproportionof patientsatparticipatingNCORPpracticeswhocompletetheENABLEprogram;?2)Comparetheeffectiveness ofVLCvs.TAonNCORPpracticesimplementationteams?fidelitytoENABLEandassignedimplementation strategy;?3)CompareNCORPpracticesrandomizedtoVLCorTAonpatientandcaregiverqualityoflife(QOL) andmoodoutcomes;?and4)DeterminetherelationshipbetweenENABLEprogramuptakeandfidelityand patients?QOLandmoodacrossthetwostrategies.Thisresearchwillimpactpublichealthbyaddressinga knowledgegaponappropriatestrategiestoimplementscalableevidence-basedpalliativecarepracticeswhile reducingthedisparityofsub-optimalcancercareforadvancedcancerpatients.

Public Health Relevance

Theproposedresearchisrelevanttopublichealthintwoways.First,theENABLE(Educate,Nurture,Advise, BeforeLifeEnds)earlypalliativecaretelehealthmodelseekstoimproveoutcomes(i.e.,qualityoflife, symptomburden)foradvancedcancerpatientsandcaregivers.Second,thisresearchwilladdtoknowledge aboutappropriateimplementationstrategiestointegratepalliativecareservicesintooncologyclinicsfor advancedcancerpatients.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA229197-03
Application #
9789846
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Castro, Kathleen M
Project Start
2018-09-24
Project End
2023-08-31
Budget Start
2019-09-01
Budget End
2020-08-31
Support Year
3
Fiscal Year
2019
Total Cost
Indirect Cost

  Institution

Name
Dartmouth-Hitchcock Clinic
Department
Type
DUNS #
150883460
City
Lebanon
State
NH
Country
United States
Zip Code
03756