Cancer, Late Effects
Conditions
Keywords
Patient-reported outcomes, Survivorship, Oncology, Implementation science, RE-AIM, Proctor Outcomes, Stepped-care
Brief summary
FRAME is a patient-centered survivorship care model embedded in routine oncology visits. It consists of: (1) a pre-visit patient-reported questionnaire (FRAME-PRO), (2) a clinician-patient dialogue guided by the responses, and (3) a tailored management plan including stepped-care referrals (general practitioner and municipality; oncology department supportive services; specialized late-effects clinics). The implementation is evaluated with the RE-AIM framework supplemented by Proctor implementation outcomes. Data sources include the Mit Sygehus app, departmental registries, purpose-built questionnaires, fidelity checklists, and qualitative interviews with clinicians, patients, and informal caregivers.
Detailed description
The project implements FRAME at the Department of Oncology, Vejle Hospital. The FRAME-PRO enables patients and informal caregivers to reflect on late effects and needs before the visit. During the visit, clinicians access FRAME-PRO electronically to prioritize what matters most, assess severity (triage), and co-create a management plan documented in the electronic health record using a purpose-developed standard phrase to support cross-sector information transfer. Implementation strategies are informed by the Expert Recommendations for Implementing Change (ERIC) and local logs (education, audit & feedback, reminders, local champions, technical assistance). Evaluation follows RE-AIM: Reach (completion of FRAME-PRO), Effectiveness (referrals to supportive care, quality of life, time use), Adoption (clinician use), Implementation (fidelity to opening, discussing, and managing needs), and Maintenance (sustained use). Quantitative data are summarized descriptively; qualitative data are analyzed with content analysis. Ethics approval covers interviews with patients, caregivers, and clinicians.
Interventions
BEHAVIORALFRAME model (questionnaire + dialogue + management plan)
Administration of the patient-developed FRAME-PRO prior to the visit; clinician-patient dialogue guided by responses; stepped-care management/referrals; documentation via standard EHR phrase. Implementation strategies include educational meetings/materials, ongoing training, audit & feedback at weekly huddles, reminders/prompts, local champions, and local technical assistance.
Sponsors
Vejle Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
\- All oncologists conducting outpatient visits at the Department of Oncology, Vejle Hospital during the study period.
Exclusion criteria
\- None. Participants for interviews: * A purposive sample of patients, informal caregivers, and clinicians approached ≥6 months after launch * written and verbally informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of oncologists who actively use FRAME in ≥50% of eligible outpatient visits. | 3 months | Adoption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in proportion of visits/patients with referrals to supportive care units compared with pre-implementation baseline. | Up to 6 months | Effectiveness. Target: +15% (exploratory). |
| Change in patient-reported global quality of life measured on a Likert-like scale from 1 (poor) to 5 (excellent). | Up to 6 months | Effectiveness. Target: +10% relative increase (exploratory). |
| Degree to which clinicians and patients (a) open FRAME-PRO during the visit (yes/no), (b) discuss reported needs (yes/no), and (c) manage needs aligned with preferences (yes/no) | Up to 6 months | Implementation / fidelity |
| Perceived feasibility of active FRAME use among clinicians on a likert-like scale from 1 (not feasible) to 5 (very feasible) | 6 months | Feasibility of FRAME (Proctor outcome) |
| Clinician-perceived acceptability of FRAME-supported visits on a scale from 1 (not acceptable) to 5 (very acceptable) | 6 months | Acceptability (Proctor outcome) |
| Proportion of eligible outpatient visits with completed FRAME-PRO (via Mit Sygehus). | Continuously during implementation (up to 6 months) | Reach |
| Time needed to include FRAME-PRO in the visit on a scale from 1 (definitely shorter time with FRAME) to 5 (definitely longer time with FRAME). | 6 months | Cost |
| Integration of FRAME within the outpatient clinic (e.g., percent of clinicians using FRAME routinely) | 6 months | Penetration |
| Sustained active use of FRAME among clinicians in the last 3 months of the study window. | Up to 12 months | Maintenance |
| Proportion of patients referred to supportive care units (actual numbers) | 6 months | Effectiveness |
| Perceived fit of FRAME to the oncology outpatient setting and patient population on a scale from 1 (not appropriate) to 5 (very appropriate). | 6 months | Appropriateness (Proctor outcome) |
Countries
Denmark
Contacts
Primary ContactJohanne D Lyhne, PhD
Backup ContactKarin Larsen
Outcome results
None listed