Cancer Survivorship, Primary Care
Conditions
Keywords
cancer survivorship, primary care practice
Brief summary
Rural cancer survivors experience a higher risk of negative health outcomes and require coordinated care to address the many effects of cancer and its treatment. Primary care providers recognize the importance of providing high-quality, evidence-based survivorship care and are well-positioned to meet survivor needs, however, these needs are often unmet due to limitations in knowledge, lack of resources, and administrative demands. Practical strategies are needed to help PCPs improve cancer survivorship care, and this proposal will test implementation strategies to optimize the adoption of evidence-based practices for cancer survivorship care in rural primary care settings.
Detailed description
Cancer survivors require long-term and coordinated care to address the physical, emotional, and psychosocial effects of cancer and its treatment. Rural cancer survivors are disproportionately affected by chronic illness and face a higher risk of negative health outcomes. Primary care providers (PCPs) recognize the importance of delivering evidence-based practice (EBP) cancer survivorship care and are well-positioned to provide comprehensive and coordinated care, however, the needs of cancer survivors are frequently unmet, and providers describe limitations in knowledge of risk-based surveillance, long-term effects of cancer treatment and their management, inadequate resources, and growing administrative demands as barriers to improving survivorship care. The overall goal of this project is to test the effectiveness of pragmatic strategies to promote high quality, evidence-based guideline concordant care for rural adult cancer survivors in primary care practice and utilizing tools from implementation science to gain a better understanding of the decision making and actions taken that facilitate or hinder implementation across multiple healthcare systems. To achieve this objective, we propose a three-arm cluster-randomized, multi-level intervention to provide education, tele-mentoring, and whether 1) virtual scribes filling the role as trained medical assistants, 2) a team-based approach, 3) or usual care produces more guideline concordant cancer survivorship care. The primary outcome is provider adherence to EBP cancer survivorship guidelines as measured using a previously developed composite scoring system that compares electronic health record (EHR) documented activity to National Comprehensive Cancer Network guidelines. The secondary outcome is to assess intervention sustainability of arm 1 and 2 activities at 12 and 24-months post implementation; measured as a function of virtual scribe or team-based actions to promote prior cancer diagnoses coding (ICD-10), use of EHR tools and health maintenance order sets and annual ordering of appropriate screenings for cancer survivors. Prior to implementation, formative evaluations will assess current systems of care and practice-level barriers and facilitators for the delivery of EBP cancer survivorship care and inform modifications to implementation strategies. Guided by the Normalization Process Theory, we will examine agentic factors (e.g., actions taken/decisions made by the practice) to modify modes of care management and delivery. The RE-AIM evaluation framework will be used to explore potential population-level impact and generalizability of the intervention in real-world clinical settings. The study will be conducted in 16 rural primary care practices in Kansas and was intentionally designed to bring care delivery changes into resource-limited practices and health systems. Results will add new evidence by informing pragmatic strategies to facilitate the adoption and delivery of EBP cancer survivorship in rural primary care.
Interventions
OTHERVirtual scribe services
Participating practices who opt-in to receive virtual scribe services.
OTHERKanSurvive telementoring and education
Telementoring, education, and case-based learning covering evidence-based practice guidelines for breast, colorectal, lung, and prostate cancer survivorship.
OTHERPractice facilitation for quality improvement
Practice facilitation will be delivered to assist with quality improvement efforts using monthly Plan Do Study Act (PDSA) cycles.
OTHERObesity management toolkit
The Enhanced Usual Care arm will receive a short, virtual training and toolkit on the management of obesity in primary care practice and how it relates to cancer survivorship.
OTHERSurvivorship Care Manual
Printed and digital manuals will be distributed to each participating primary care practice to share with the cancer survivors they see in their clinic. The manual guides patients on how to engage more effectively with their PCP and oncology care team and reviews recommended follow-up, within a format of a "service manual" and written in lay language.
Sponsors
University of Kansas Medical Center
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
8 rural primary care practices will be randomized to the Virtual Scribe Medical Assistant arm, 4 rural primary care practices will be randomized to the Team-Based Care arm, and 4 rural primary care practices will be randomized to the Enhanced Usual Care control arm.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
1. Rural primary care practice (PCP) located within rural urban continuum codes (RUCC) 4-9 in Kansas 2. PCPs must have multiple providers 3. PCPs must have at least on medical assistant 4. PCPs must have an employed medical scribe or be willing to consider employing a medical scribe using study compensation and practice revenue 5. 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 not located within RUCC 4-9 in Kansas 2. PCPs without multiple providers 3. PCPs without a medical assistant 4. PCPs without a medical scribe or unwilling to consider employing one 5. Cancer survivorship data is ineligible for extraction is 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 |
|---|---|---|
| Provider Adherence to Cancer Survivorship Guidelines Measured by EHR-Based Composite Adherence Score | Assessed at baseline, 6, 12, and 24 months | The primary outcome is provider adherence to evidence-based cancer survivorship guidelines, measured using a composite score derived from electronic health record (EHR) data abstraction. The composite score assesses concordance between documented care and National Comprehensive Cancer Network (NCCN) survivorship guidelines across multiple domains (e.g., tumor surveillance, distress screening, BMI assessment, tobacco use screening, family history of cancer documentation, osteoporosis screening, and hereditary cancer risk assessment). Scores are calculated based on the proportion of eligible guideline-concordant care processes completed for each patient and aggregated at the clinic level. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAllen K Greiner, MD, MPH
University of Kansas Medical Center
Outcome results
None listed