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Principal Investigator: Erin Faye Gillespie
Organization: UNIVERSITY OF WASHINGTON
Fiscal Year: 2024
Award: $263,033
Funding agency: National Cancer Institute
PROJECT SUMMARY/ABSTRACT
The overall goal of this NCI K08 career development proposal is to facilitate Dr. Erin Gillespie’s
development into an independent investigator in cancer health services research focusing on strategies to
enhance quality and evidence-based care in radiation oncology. This proposal focuses on shortening the
course of radiation from 7-9 weeks to 3-5 weeks (called “hypofractionation”) which is associated with
equivalent cancer control, improved patient-reported outcomes, and decreased costs in patients with breast
and prostate cancer. Nonetheless, adoption has been slow. Dr. Gillespie’s prior work has revealed that the
individual radiation oncologist is highly influential in whether patients with breast cancer receive
hypofractionation or a longer course of radiation.
The overall hypothesis is that radiation oncologists are the linchpin in radiation treatment decision-
making, and that implementation strategies that harness behavioral economics will be most likely to impact
practice change. My primary objectives are to 1) identify and characterize positive deviant radiation oncologists
(high users of hypofractionation) that will 2) elucidate implementation strategies and associate them with
adoption of hypofractionation across various settings, and 3) pilot test a multi-pronged strategy that promotes
use of hypofractionation in preparation for a large pragmatic multi-center controlled trial. The rationale that
underlies the proposed research and training plan is that, with new knowledge about the levers that drive
physician decision-making (beyond knowledge gaps), healthcare leaders and policymakers can optimally
design and implement systems that evoke change. Dr. Gillespie will harness the resources and expertise at
Memorial Sloan Kettering Cancer Center, where she is a faculty member in the Department of Radiation
Oncology and the Center for Health Policy and Outcomes. She is also engaged in research in the community-
based setting through the MSK Cancer Alliance. Her training plan has a foundation of implementation science
that incorporates large dataset analysis, mixed methods, and behavioral economic theory.
In Aim 1 of the proposed study, the investigators will analyze a Medicare dataset that includes claims
linked to prescribing radiation oncologist and organization, and is supplemented by the AMA Masterfile. They
will systematically conduct the first-ever evaluation of implementation strategies in radiation oncology using
mixed methods. Lastly, in Aim 3 the investigators will develop and pilot test a multi-pronged strategy informed
by Aims 1-2 and including audit and feedback. This proposal, together with the new skills Dr. Gillespie will
acquire, will generate new knowledge about the impact of implementation strategies on de-implementation of
long-course radiation – key parameters necessary to design optimal strategies to encourage physicians to
adopt high value radiation. This will specifically support the development of an implementation strategy that will
be tested in a subsequent prospective randomized trial to assess real world efficacy.
Terms: <Acceleration><Address><Adopted><Adoption><Assess implementation><Breast Cancer><Cancer Burden><Cancer Control><Cancer Control Science><Cancer Treatment><Cancers><Caring><Clinical Paths><Clinical Pathways><Communities><Coupled><Data Set><De-implementation><Decision Making><Deimplementation><Development><Evidence based practice><Faculty><Feedback><Foundations><Funding><Goals><Guidelines><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Policy><Health Services Evaluation><Health Services Research><Healthcare><Hospitals><Implementation assessment><Improve Access><Incentives><Individual><Influentials><Institution><Investigators><Knowledge><Leadership><Link><MSKCC><Malignant Breast Neoplasm><Malignant Neoplasm Therapy><Malignant Neoplasm Treatment><Malignant Neoplasms><Malignant Tumor><Malignant Tumor of the Prostate><Malignant neoplasm of prostate><Malignant prostatic tumor><Maps><Medical Care Research><Medicare><Memorial Sloan-Kettering Cancer Center><Mentors><Mentorship><Methodology><Methods><NIH><National Cancer Burden><National Institutes of Health><Outcome><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Peer Review><Performance><Physicians><Policy Maker><Population Study><Preparation><Prostate><Prostate CA><Prostate Cancer><Prostate Gland><Prostate malignancy><Prostatic Cancer><Prostatic Gland><Public Health><Publications><Publishing><QOL><Quality of life><Radiation><Radiation Oncologist><Radiation Oncology><Radiation therapy><Radiotherapeutics><Radiotherapy><Randomization trial><Reporting><Research><Research Personnel><Research Proposals><Research Resources><Researchers><Resources><Scientific Publication><Scientist><System><Taxes><Testing><Title 18><Training><Translating><United States><United States National Institutes of Health><Variant><Variation><Work><anti-cancer therapy><behavioral economics><cancer care><cancer therapy><cancer-directed therapy><career development><clinical practice><community partners><community-based partners><cost><density><design><designing><developmental><deviancy><deviant><evaluate implementation><evaluation of implementation><evidence base><experience><health care><health care policy><health insurance for disabled><healthcare policy><human centered design><implementation evaluation><implementation science><implementation strategy><improved><insight><large data sets><large datasets><malignancy><malignant breast tumor><member><neoplasm/cancer><patient centered><patient oriented><patient oriented outcomes><pilot test><population-based study><population-level study><practice setting><preparations><prospective><radiation treatment><randomized trial><randomized, clinical trials><services research><skills><social><strategies for implementation><studies of populations><study of the population><theories><treatment with radiation><uptake>