Principal Investigator: Emily V. Dressler, PhD
Cluster randomized trials collect implementation adoption and fidelity outcomes using mixed methods from sites, providers, and/or participants. It is unclear how best to collate and summarize these complex data. Using data from the OaSiS trial (WF-02817CD): Implementation of Smoking Cessation Services within NCI Community Oncology Research Program (NCORP) Sites with Organized Lung Cancer Screening (LCS) Programs, we explore various approaches to integrate multi-level data to measure adoption and fidelity, using tobacco use treatment (TUT) as an example. OaSiS is a cluster randomized, hybrid effectiveness-implementation trial to assess TUT strategies for current smokers undergoing LCS. Intervention clinics created an action plan for embedding TUT into LCS workflow with staff responsible for all implementation with virtual coaching. Primary objective was smoking cessation at 6 months. Mixed methods were utilized to collect clinic-level data regarding TUT strategies offered pre- and post-implementation. Patient participants reported TUT services received after LCS. To assess adoption, we compare various categorizations of clinic TUT integration pre- and post-implementation using: sum of services, grouping as services added, lost, or no change, and classification of evidence-based practices (Ask, Advise, Assist/Refer). All clinics must ask and advise to be classified as not needing improvement; adequate clinics also offered quitline or educational materials, good clinics offered medication or counseling, and optimal offered both. Fidelity outcomes included correlation of participant-reported services received with clinic-reported offerings.
The Specific Aims of this project are:
Aim 1: Assess which TUT services (or combination of services) offered to participants predict success in smoking cessation in the OaSiS trial and compare and contrast various analytic approaches.
Aim 2: Assess various approaches to quantify translation and implementation within the OaSiS trial. This will be conducted on all possible TUT services asked on the survey as well as the focused subgroup of services identified in Aim 1. We will perform sensitivity analyses with various statistical approaches.
Aim 3: Combine measures TUT services identified in Aim 1 with measures of adoption and implementation in Aim 2 in final trial models of smoking cessation.