iDAPT P50 Implementation Science Center in Cancer Control

Principal Investigator: Stephanie Sohl, PhD 
Co-Investigators: Drs. Wentworth, Weaver, Dressler, Sadasivam, Houston 

The SHARE-S Implementation Program enhances survivorship care planning (SCP) implementation through leveraging technology to further prepare patients for an SCP visit, enhancing an SCP visit with self-management coaching to increase SCP engagement, and providing follow-up support for adherence to the SCP guidelines that require self-management (e.g., symptom management, healthy behaviors). The Specific Aims are: 

Aim 1: Clinic Implementation Program - Gather stakeholder feedback on the electronic referral tool and the technology content for the computer-tailored communication system.  
Aim 2: Patient Communication Tool - Adapt technology to create a prototype intervention program to facilitate cancer SCP.  
Aim 3: SHARE-S Pilot study: Conduct a pilot study testing the study protocols and implementation program. 

Principal Investigator: Jinying Chen, PhD   
Co-investigators: Drs. Houston, Cutrona, Dharod 

Monitoring implementation processes, including fidelity, is crucial for understanding implementation, adapting implementation programs, and comparing effectiveness of implementation strategies. Common approaches for assessing implementation fidelity often rely on self-report data or observational data collected by direct observation or audio/video recording. These approaches are difficult to scale for large implementation efforts. Technology-enabled fidelity measures have the potential to address this challenge.   

This methods pilot study builds on Dr. Chen’s expertise in machine learning and her recent trainings in implementation research through the NCI-funded PRACCTIS post-doctoral fellowship at UMMS.  The Specific Aims are: 

Aim 1: Monitoring Intended, Direct Effects of Implementation: Using EHR access and audit logs, develop automatic metrics that measure the fidelity of implementation.  As a demonstration of the methods, we will take advantage of the implementation, in 2019, of a new detailed smoker status assessment with automated clinical alerts to clinical providers in the Wake Forest Comprehensive Cancer Center. 

Aim 2: Monitoring Overall patterns of clinical team-EHR activity: Develop methods to classify overall patterns of use, and Compare EHR use patterns before and after the launch of an implementation program that promotes the completion of smoking screening during clinic visits. This is an exploratory aim with the goal of identifying latent patterns of change in use of the EHR that can be used to monitor implementation, and can be adapted to any implementation program.   

 

Principal Investigator: Dan Amante, PhD 
Co-investigators – Drs. Houston, Foley, Cutrona, Hogan (also receiving in-kind support from the following junior faculty as reviewers: Jamie Faro, Maryum Zaidi, Ekaterina (Katya) Anderson) 

Specific Aim: In this pilot, a ‘realist synthesis’ review approach is being deployed to understand best practices for pre-implementation of eHealth technology-assisted implementation science research.  

Status: In this reporting period, two working groups (labeled as stakeholders and reviewers) have regularly convened to review the literature and iteratively refine the focus of the realist synthesis. A purposive, theoretically driven search strategy has been initiated with guidance from medical librarians and tools for screening and appraisal of evidence have been developed and pilot tested. This pilot will be completed and results published in the next reporting period.   

Pilot #3 will be completed during Year 3 of iDAPT.   

Principal Investigator:  Mayuko Ito Fukunaga, MD 
Co-investigators: Drs. Houston, Wiender, Mazor, Bankier, Pbert, Hogan 

Adherence to annual follow up is critical to achieving mortality benefits and optimizing cost-effectiveness of lung cancer screening (LCS). However, current adherence to follow up in LCS is suboptimal. The goal of Tele-Navi LCS is to increase adherence in LCS by improving patient awareness of its importance and promoting effective patient-provider communication about the results of LDCT. The project will use Clinical Video Telehealth as a core component of a strategy to increase follow-up. 

The Specific Aims of this research proposal are to: 

Aim 1: Develop Tele-Navi LCS, using a co-production approach with patients at UMMHC, and refine Tele-Navi LCS based on feedback from LCS stakeholders at UMMHC, Wake Forest, and UCHealth (University of Colorado). 

Aim 2: Pilot test Tele-Navi LCS and evaluate its feasibility, acceptability, and associated costs by implementing it in the clinical LCS workflow in two primary care clinics at UMMHC. 

Principal Investigator:: Emily R Haines, PhD  
Co-investigators: Drs. Lux, Smitherman, Swift, Matson, Salsman, Birken 

To facilitate a systematic and patient-centered approach to delivering services to address the unmet AYAs with cancer, we developed the AYA Needs Assessment & Service Bridge (AYA NA-SB).  AYA NA-SB includes (1) a holistic patient-reported outcome measure assessing AYAs’ physical, psychosocial and practical needs, and (2) a collection of referral pathways for connecting AYAs to services based on the needs they report.  In this pilot study, we will evaluate AYA NA-SB’s implementation and establish proof-of-concept for the intervention. 

The Specific Aims are: 

Aim 1: Assess the implementation of AYA NA-SB. We will pilot AYA NA-SB in the University of North Carolina Lineberger Comprehensive Cancer Center among n=50 AYAs with a primary focus on implementation outcomes (i.e., feasibility, acceptability, appropriateness, fidelity).  

Aim 2: Establish proof-of-concept for AYA NA-SB. We will use pilot data to generate preliminary evidence on the extent to which AYA NA-SB addresses AYAs’ reported needs.  

Multiple Principal Investigators: Elise Stevens, PhD and Rajani Sadasivam, PhD 

Automated computer-tailored health communication systems deliver motivational messages and cues to patients.  However, few trials have implemented these systems into the workflow of clinical practice.  These systems can be used pre-visit or between visits to reinforce patient-provider communication about health behaviors, needed screening tests, and health goal setting. Recent advances in patient messaging systems include the use of mobile phones to collect contextual factors (e.g., location or current participant stress) to develop just-in-time tailoring. Mood, a critical contextual factor often incorporated in commercially used algorithms, has not been incorporated into patient-messaging systems.  

In this pilot, we use a novel method to understand how the mood of individuals who smoke influences the response to smoking cessation messages. These results would help design a new patient messaging system that will use mood to determine what messages to send and when messages are sent. We plan to test the integration of this mood-based system in clinical practices. This pre-implementation pilot will use clinical stakeholder input to refine the messaging system with the goal of increasing engagement in the messaging system, and with the ultimate goal of increasing patient use of services offered by the clinical system in future visits.   

The Specific Aims of this project are: 

Aim 1: Using psychophysiological technology in an in-lab setting, determine how mood states (positive, neutral, negative) impact 60 adult smokers' cognitive resources allocated to the message, arousal levels, and visual attention to smoking cessation messages. 

Aim 2: Using crowdsourcing, determine how mood states (positive, neutral, negative) impact 600 adult smokers' self-reported relevancy, receptivity, and motivations to quit in response to smoking cessation messages. 

Aim 3: Integrate results of Aim 1 and 2 and rank optimal quit smoking messages for each mood state using Multi-Attribute Decision Making Models. 

Multiple Principal Investigators: Emily R. Haines, PhD and Thomas Houston, MD, MPH 

In this study, we are conducting semi-structured qualitative interviews with Atrium Health/Wake Forest Baptist providers from across disciplines to assess their experiences with clinical video telehealth and their perceptions on the multilevel determinants of implementing clinical video telehealth.   

The Specific Aims of this project are: 

Aim 1: Conduct semi-structured qualitative interviews with approximately 50 Atrium Health Wake Forest Baptist providers to assess their experiences with clinical video telehealth and their perceptions on the multilevel determinants of implementing clinical video telehealth. 

Multiple Principal Investigators: Sarah A. Birken, PhD and Emily R. Haines, PhD 

In this study, we are developing tools to optimize implementation by harmonizing interventions, contexts, and implementation strategies. After developing a prototype of the harmonization tools by soliciting iterative feedback from our design team of implementation experts, we will conduct usability testing to further refine the tools. 

The Specific Aims of this project are: 

Aim 1: Engage a multidisciplinary design team to develop tools to optimize implementation by harmonizing interventions, contexts and implementation strategies.  

Aim 2: Conduct usability testing with NCORP hybrid investigators, including those pursuing trials testing technology assisted interventions, to review and refine the harmonization tools developed in Aim 1 in paper and web-based formats. 

Aim 3: Pilot the harmonization tools in a proposed hybrid trial. 

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.