Breast Cancer, Colorectal Cancer, Lung Cancer, Prostate Cancer
Conditions
Keywords
Cancer Survivorship, Rural Primary Care Practices
Brief summary
Approximately, 20 rural primary care practices to participate in a delayed intervention-controlled trial. Phase I: Formal and structured work flow evaluations to better identify specific gaps in processes of care while assessing what on-going training is needed for adoption of high-quality cancer survivorship care in rural practice. These will be incorporated into the ECHO sessions (Aim 1). Phase II: Conduct and test the effectiveness of the novel KanSurvive-ECHO intervention (Aim 2) and finally identify barriers and facilitators to implementation of KanSurvive-ECHO (Aim 3).
Detailed description
While evidence-based practice (EBP) guidelines exist for cancer survivorship care, implementation in rural practices has fallen short. Approximately 72.5% of Kansas cancer survivors who have completed their cancer treatment receive a majority of their health care from Primary Care Providers, yet these providers describe a lack of basic awareness of risk-based surveillance, effects of cancer treatment and their management, as well as inadequate resources, and growing administrative demands as reasons for not working to improve survivorship care. These factors may also prevent shared care management of cancer survivors between primary care and rural oncology care providers. There is a pressing need to understand primary care practice capacity to implement guideline informed management and follow-up for cancer survivors in the acute and extended phases of care. Specific Aim 1. Formally assess gaps in processes of care and additional training needed to result in actual adoption of high-quality care for acute and chronic survivors of breast, colorectal, lung, and prostate cancer in 20 rural primary care practices. Utilize this formative information to further refine the KanSurvive-ECHO. Specific Aim 2. Evaluate the effectiveness of KanSurvive-ECHO for enhancing evidence-based survivorship care for rural breast, colorectal, lung, and prostate cancer survivors. Hypothesis: Compared to delayed intervention control, rural primary care practices randomized to KanSurvive-ECHO will demonstrate greater concordance with evidence-based survivorship care guidelines as measured by a composition score determined by change in EHR documentation consistent with guideline concordant care. Specific Aim 3: Utilizing the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework describe key facilitators and barriers to implementation of KanSurvive-ECHO including innovation, recipients, context, and facilitation. This novel project will provide a model for development of a community of practice using practice facilitation and Project ECHO to improve the management and follow-up of cancer survivors in the acute and extended phases of cancer survivorship.
Interventions
OTHERKanSurvive ECHO and Practice Facilitation
Four, 1-hour, virtual, case-based education sessions covering the evidence-based practice guidelines for breast, colorectal, lung, and prostate cancer survivorship care. Practice facilitation also provided to support participating primary care practices with quality improvement in the delivery of cancer survivorship care.
Sponsors
National Cancer Institute (NCI)
University of Kansas Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Single-arm feasibility study aimed at evaluating the effectiveness of the KanSurvive ECHO intervention combined with practice facilitation to promote the adoption of evidence-based practice survivorship care guidelines.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
1. Primary care practice (PCP) caring for rural cancer survivors 2. Willing to participate in four ECHO sessions 3. Capable and willing to complete pre- and post- data collection under a data use agreement 4. Cancer survivor data is eligible for extraction if the patient is a breast, prostate, lung, and/or colorectal cancer survivor and considered to have a reasonable likelihood of 24-month survival by a practice provider.
Exclusion criteria
1. PCPs unwilling to engage in project activities 2. PCPs with no rural-dwelling patients on their patient panel 3. Cancer survivor data is ineligible for extraction if the patient is \<18 years of age or \>75 years of age, is currently receiving hospice services, or has a history of cancer other than breast, prostate, lung, or colorectal.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tumor Surveillance Completion (Pre-Intervention) | Baseline (Pre-Intervention) Chart Audit | This outcome reflects whether recommended tumor surveillance was completed and documented in the EHR. Tumor surveillance includes cancer-specific follow-up imaging consistent with evidence-based survivorship guidelines (e.g., NCCN, ASCO). Charts were coded as Completed if the recommended surveillance test was documented within the appropriate interval and Not Completed if documentation was absent, outdated, or incomplete. The outcome reports the proportion of EHR charts meeting tumor surveillance recommendations at baseline (pre-intervention) and again 24 months after the intervention. |
| Tumor Surveillance Completion (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | This outcome reflects whether recommended tumor surveillance was completed and documented in the EHR. Tumor surveillance includes cancer-specific follow-up imaging consistent with evidence-based survivorship guidelines (e.g., NCCN, ASCO). Charts were coded as Completed if the recommended surveillance test was documented within the appropriate interval and Not Completed if documentation was absent, outdated, or incomplete. The outcome reports the proportion of EHR charts meeting tumor surveillance recommendations at baseline (pre-intervention) and again 24 months after the intervention. |
| Distress Screening Completion (Pre-Intervention) | Baseline (Pre-intervention) Chart Review | This outcome reflects whether recommended Distress Screening was completed and documented in the EHR. Distress Screening was defined as documentation of using a standardized distress assessment tool consistent with survivorship best practices. Charts were coded as Completed when a distress screening result was documented during the chart abstraction interval. Not Complete indicated missing or incomplete documentation. |
| Distress Screening Completion (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | This outcome reflects whether recommended Distress Screening was completed and documented in the EHR. Distress Screening was defined as documentation of using a standardized distress assessment tool consistent with survivorship best practices. Charts were coded as Completed when a distress screening result was documented during the chart abstraction interval. Not Complete indicated missing or incomplete documentation. |
| Body Mass Index (BMI) Assessment Completion (Pre-Intervention) | Baseline (Pre-intervention) Chart Review | BMI assessment was defined as documentation of a height and weight measurement sufficient to calculate body mass index (BMI) in the electronic health record (EHR). Charts were coded as Completed when BMI or its components were documented within the recommended timeframe. |
| Body Mass Index (BMI) Assessment Completion (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | BMI assessment was defined as documentation of a height and weight measurement sufficient to calculate body mass index (BMI) in the electronic health record (EHR). Charts were coded as Completed when BMI or its components were documented within the recommended timeframe. |
| Tobacco Use Screening Completion (Pre-Intervention) | Baseline (Pre-Intervention) Chart Audit | Tobacco use screening was defined as documentation of current tobacco use status in the electronic health record (EHR). Charts were coded as Completed when a screening result was documented within the recommended timeframe. |
| Tobacco Use Screening Completion (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | Tobacco use screening was defined as documentation of current tobacco use status in the electronic health record (EHR). Charts were coded as Completed when a screening result was documented within the recommended timeframe. |
| Cancer Diagnosis on Problem List (Pre-Intervention) | Baseline (Pre-Intervention) Chart Audit | This outcome reflects whether a cancer diagnosis was documented on the patient's EHR problem list, consistent with survivorship care documentation standards. Charts were coded as Completed when the cancer diagnosis appeared in the structured problem list. |
| Cancer Diagnosis on Problem List (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | This outcome reflects whether a cancer diagnosis was documented on the patient's EHR problem list, consistent with survivorship care documentation standards. Charts were coded as Completed when the cancer diagnosis appeared in the structured problem list. |
| Family History of Cancer Documentation (Pre-Intervention) | Baseline (Pre-intervention) Chart Audit | Family history of cancer documentation was defined as the presence of cancer-related family history information in the EHR. Charts were coded as Completed when documentation included a family history of cancer assessment entry. |
| Family History of Cancer Documentation (Post-Intervention) | 24-Month Follow-Up (Post-Intervention) Chart Audit | Family history of cancer documentation was defined as the presence of cancer-related family history information in the EHR. Charts were coded as Completed when documentation included a family history of cancer assessment entry. |
Countries
United States
Participant flow
Recruitment details
Clinics were the unit of assignment. The intervention was delivered at the clinic level. Outcome data were collected through retrospective, de-identified EHR chart reviews. Participants represent chart abstractions for cancer survivors seen during two independent audit periods: a baseline (pre-intervention) chart audit and a 24-month post-intervention chart audit. These audit samples were drawn from the same participating clinics but do not represent the same individual cancer survivors.
Participants by arm
| Arm | Count |
|---|---|
| Baseline (Pre-Intervention) Chart Audit This arm represents the baseline, pre-intervention chart audit sample drawn from participating primary care clinics prior to implementation of the KanSurvive ECHO + Practice Facilitation intervention.
Charts included in this audit reflect an independent analytic sample of cancer survivors and do not necessarily represent the same individuals included in the baseline chart audit.
Demographic characteristics were abstracted at this time point (Baseline) to describe the post-intervention sample.
Analyses are descriptive and no inferential comparisons were conducted between baseline and post-intervention samples. | 138 |
| 24-Month Follow-Up (Post-Intervention) Chart Audit This arm represents the 24-month post-intervention chart audit sample drawn from the same participating primary care clinics following implementation of the KanSurvive ECHO + Practice Facilitation intervention.
Charts included in this audit reflect an independent analytic sample of cancer survivors and do not necessarily represent the same individuals included in the baseline chart audit.
Demographic characteristics were abstracted at this time point (Post) to describe the post-intervention sample.
Analyses are descriptive and no inferential comparisons were conducted between baseline and post-intervention samples. | 129 |
| Total | 267 |
Baseline characteristics
| Characteristic | Baseline (Pre-Intervention) Chart Audit | 24-Month Follow-Up (Post-Intervention) Chart Audit | Total |
|---|---|---|---|
| Age, Continuous | 64.5 years STANDARD_DEVIATION 7.7 | 63.0 years STANDARD_DEVIATION 9.6 | 63.8 years STANDARD_DEVIATION 8.65 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 3 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 121 Participants | 125 Participants | 246 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 14 Participants | 1 Participants | 15 Participants |
| Number of EHR charts analyzed at baseline | 138 EHR charts | 129 EHR charts | 267 EHR charts |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 30 Participants | 32 Participants |
| Race (NIH/OMB) White | 130 Participants | 96 Participants | 226 Participants |
| Sex: Female, Male Female | 74 Participants | 67 Participants | 141 Participants |
| Sex: Female, Male Male | 64 Participants | 62 Participants | 126 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Body Mass Index (BMI) Assessment Completion (Post-Intervention)
BMI assessment was defined as documentation of a height and weight measurement sufficient to calculate body mass index (BMI) in the electronic health record (EHR). Charts were coded as Completed when BMI or its components were documented within the recommended timeframe.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Body Mass Index (BMI) Assessment Completion (Post-Intervention) | 118 Participants |
Primary
Body Mass Index (BMI) Assessment Completion (Pre-Intervention)
BMI assessment was defined as documentation of a height and weight measurement sufficient to calculate body mass index (BMI) in the electronic health record (EHR). Charts were coded as Completed when BMI or its components were documented within the recommended timeframe.
Time frame: Baseline (Pre-intervention) Chart Review
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Body Mass Index (BMI) Assessment Completion (Pre-Intervention) | 132 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Fisher Exact
Primary
Cancer Diagnosis on Problem List (Post-Intervention)
This outcome reflects whether a cancer diagnosis was documented on the patient's EHR problem list, consistent with survivorship care documentation standards. Charts were coded as Completed when the cancer diagnosis appeared in the structured problem list.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Cancer Diagnosis on Problem List (Post-Intervention) | 122 Participants |
Primary
Cancer Diagnosis on Problem List (Pre-Intervention)
This outcome reflects whether a cancer diagnosis was documented on the patient's EHR problem list, consistent with survivorship care documentation standards. Charts were coded as Completed when the cancer diagnosis appeared in the structured problem list.
Time frame: Baseline (Pre-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Cancer Diagnosis on Problem List (Pre-Intervention) | 129 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Fisher Exact
Primary
Distress Screening Completion (Post-Intervention)
This outcome reflects whether recommended Distress Screening was completed and documented in the EHR. Distress Screening was defined as documentation of using a standardized distress assessment tool consistent with survivorship best practices. Charts were coded as Completed when a distress screening result was documented during the chart abstraction interval. Not Complete indicated missing or incomplete documentation.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Distress Screening Completion (Post-Intervention) | 116 Participants |
Primary
Distress Screening Completion (Pre-Intervention)
This outcome reflects whether recommended Distress Screening was completed and documented in the EHR. Distress Screening was defined as documentation of using a standardized distress assessment tool consistent with survivorship best practices. Charts were coded as Completed when a distress screening result was documented during the chart abstraction interval. Not Complete indicated missing or incomplete documentation.
Time frame: Baseline (Pre-intervention) Chart Review
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Distress Screening Completion (Pre-Intervention) | 116 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Fisher Exact
Primary
Family History of Cancer Documentation (Post-Intervention)
Family history of cancer documentation was defined as the presence of cancer-related family history information in the EHR. Charts were coded as Completed when documentation included a family history of cancer assessment entry.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Family History of Cancer Documentation (Post-Intervention) | 115 Participants |
Primary
Family History of Cancer Documentation (Pre-Intervention)
Family history of cancer documentation was defined as the presence of cancer-related family history information in the EHR. Charts were coded as Completed when documentation included a family history of cancer assessment entry.
Time frame: Baseline (Pre-intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Family History of Cancer Documentation (Pre-Intervention) | 96 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Fisher Exact
Primary
Tobacco Use Screening Completion (Post-Intervention)
Tobacco use screening was defined as documentation of current tobacco use status in the electronic health record (EHR). Charts were coded as Completed when a screening result was documented within the recommended timeframe.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Tobacco Use Screening Completion (Post-Intervention) | 119 Participants |
Primary
Tobacco Use Screening Completion (Pre-Intervention)
Tobacco use screening was defined as documentation of current tobacco use status in the electronic health record (EHR). Charts were coded as Completed when a screening result was documented within the recommended timeframe.
Time frame: Baseline (Pre-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Tobacco Use Screening Completion (Pre-Intervention) | 115 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Fisher Exact
Primary
Tumor Surveillance Completion (Post-Intervention)
This outcome reflects whether recommended tumor surveillance was completed and documented in the EHR. Tumor surveillance includes cancer-specific follow-up imaging consistent with evidence-based survivorship guidelines (e.g., NCCN, ASCO). Charts were coded as Completed if the recommended surveillance test was documented within the appropriate interval and Not Completed if documentation was absent, outdated, or incomplete. The outcome reports the proportion of EHR charts meeting tumor surveillance recommendations at baseline (pre-intervention) and again 24 months after the intervention.
Time frame: 24-Month Follow-Up (Post-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Tumor Surveillance Completion (Post-Intervention) | 117 Participants |
Primary
Tumor Surveillance Completion (Pre-Intervention)
This outcome reflects whether recommended tumor surveillance was completed and documented in the EHR. Tumor surveillance includes cancer-specific follow-up imaging consistent with evidence-based survivorship guidelines (e.g., NCCN, ASCO). Charts were coded as Completed if the recommended surveillance test was documented within the appropriate interval and Not Completed if documentation was absent, outdated, or incomplete. The outcome reports the proportion of EHR charts meeting tumor surveillance recommendations at baseline (pre-intervention) and again 24 months after the intervention.
Time frame: Baseline (Pre-Intervention) Chart Audit
Population: Analysis population includes all EHR charts meeting inclusion criteria with complete documentation for the specified time point. Differences in sample size between baseline and post-intervention reflect routine variation in chart availability and completeness across clinics
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| KanSurvive ECHO + Practice Facilitation | Tumor Surveillance Completion (Pre-Intervention) | 126 Participants |
Comparison: Differences in cancer survivorship performance indicators and surveillance rates by tumor types before and after intervention were assessed using Fisher Exact tests.p-value: <0.05Chi-squared