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Principal Investigator: Joycelyn Lawrence
Organization: UNIVERSITY OF MIAMI CORAL GABLES
Fiscal Year: 2024
Award: $860,545
Funding agency: National Cancer Institute
Implementation of a Comprehensive Survivorship Care Intervention Across FQHC-Based Primary Care Practices
PROJECT SUMMARY
Cancer survivorship challenges adversely contribute to cancer burden, morbidity and mortality, and are
exacerbated by multiple health care and contextual barriers such as oncology provider shortages, and limited
comprehensive survivorship care services in primary care (PC). There is a critical need to integrate
comprehensive survivorship care (i.e., care coordination, prevention, surveillance and intervention) in PC
settings given a growing demand for acute cancer care by oncologists which has shifted the need to deliver
essential survivorship care in PC clinics. The rising shift towards follow-up care in PC requires that
survivorship care in those settings effectively implement and promote comprehensive survivorship care (CSC):
including adherence to best practice guidelines, care coordination and management of physical, psychosocial
and practical needs, attention to lifestyle behaviors and self-management, and optimal surveillance for new
primary cancers and/or recurrences. However, evidence-based interventions that implement these care
processes to provide risk stratified optimal care for survivors and address unmet needs of this growing population
in PC are critically lacking, and particularly in community safety net PC clinics with survivors primarily from
racial/ethnic minority and other communities with limited financial resources. Guided by the EPIS implementation
and RE-AIM evaluation frameworks, we propose a Type II effectiveness-implementation hybrid study with a
cluster randomized clinical trial to implement PC clinician training, and evaluate survivorship standard of care
(SOC; e.g., survivorship care plans), relative to a comprehensive survivorship care (CSC+SOC) intervention, on:
(a) unmet needs, health-related quality of life, lifestyle behaviors (primary outcomes), and (b) screening, health
care utilization and care quality (secondary outcomes) across 14 community clinics part of the Health Choice
Network (HCN) Federally Qualified Health Centers (FQHCs) in South Florida that provide PC to primarily
racially/ethnically diverse and low SES survivors. We will recruit 100 PC clinicians, 20 clinic and HCN leaders,
and 930 adult survivors. Our aims are: (Aim 1) Train clinicians in the SOC and CSC conditions to establish the
components of the experimental conditions and finalize the necessary infrastructure in the HCN clinics; (Aim 2)
Conduct a cluster randomized trial (3 FQHC systems with 14 clinics) that will evaluate the effectiveness of
SOC vs. CSC conditions on survivors’ unmet needs, HRQoL, lifestyle health and health care utilization and
satisfaction; and (Aim 3) Evaluate implementation and sustainability of CSC for future dissemination by
assessing determinants of successful implementation. The research team has expertise across critical areas
targeted in this U01 (e.g., psychosocial and medical oncology, primary care, health services research, e/mHealth,
EMR-integrated assessment and intervention, minority health). The 14 FQHCs clinics served over 4,300, older
(80% >50 yrs. old) survivors from diverse communities (e.g., 58% Hispanic, 23% Black; 46% Spanish speakers)
with limited financial resources (54% <$15K annual household income) in the past five years.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Access to Care><Active Follow-up><Acute><Address><Adherence><Adult><Adult Human><Aged 65 and Over><Anxiety><Area><Assess implementation><Attention><Behavior><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Black><Black race><Cancer Burden><Cancer Survivor><Cancer Survivorship><Cancers><Caring><Chronic><Clinic><Cluster randomization trial><Cluster randomized trial><Collaborations><Communication><Communities><Complex><Computerized Medical Record><Conditioning Therapy><Critical Care><Distress><Early Diagnosis><Early treatment><Economic Income><Economical Income><Education><Educational aspects><Electronic Medical Record><Environment><Espanol><Evaluation><Evidence based intervention><Evidence based program><Fatigue><Federally Qualified Health Center><Florida><Future><Guidelines><Health><Health Care Utilization><Health Services Accessibility><Health Services Evaluation><Health Services Research><Health system><Healthcare><Hispanic><Household><Implementation assessment><Income><Informatics><Infrastructure><Internet><Intervention><Intervention Strategies><Joints><Lack of Energy><Life Style><Lifestyle><Link><Long Term Survivorship><Malignant Neoplasms><Malignant Tumor><Medical Care Research><Medical Informatics><Medical Oncology><Mental Depression><Morbidity><Morbidity - disease rate><National Cancer Burden><Oncologist><Oncology><Oncology Cancer><Outcome><Pain><Painful><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patients><Physical activity><Population><Practice Guidelines><Prevention><Primary Care><Printing><Process><Provider><QOC><Quality of Care><RE-AIM><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Recurrence><Recurrent><Research><Research Design><Research Resources><Resources><Science><Second Cancer><Second Primary Cancers><Secondary Malignancy><Secondary Malignant Neoplasm><Self Management><Spanish><Spirituality><Study Type><Survivors><Symptom Burden><System><Training><Training Programs><Treatment Efficacy><WWW><Work><above age 65><access to health services><access to services><access to treatment><accessibility to health services><active followup><adulthood><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><assess effectiveness><availability of services><behavior intervention><behavioral intervention><cancer care><cancer disparity><cancer education><cancer health disparity><cancer survivor care><cancer survivorship care><cancer type><cancer-related health disparity><care access><care coordination><care services><care systems><co-morbid><co-morbidity><community based design><community based research><community clinic><community safety><comorbidity><coordinating care><depression><determine effectiveness><disparity in cancer><dissemination science><early detection><early therapy><effectiveness assessment><effectiveness evaluation><effectiveness/implementation design><effectiveness/implementation hybrid design><effectiveness/implementation hybrid study><effectiveness/implementation study><ethnic diversity><ethnic minority><ethnically diverse><evaluate effectiveness><evaluate implementation><evaluation of implementation><evidence base><examine effectiveness><follow up><follow-up><followed up><followup><health care><health care service use><health care service utilization><health related quality of life><health service access><health services availability><healthcare service use><healthcare service utilization><healthcare utilization><human old age (65+)><implementation evaluation><implementation science><implementation/effectiveness><improved><incomes><intervention efficacy><interventional strategy><longterm survivorship><low SES><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><m-Health><mHealth><malignancy><minority health><mobile health><mortality><neighborhood safety><neoplasm/cancer><nutrition><old age><oncology service><over 65 years><patient portal><patient subclass><patient subcluster><patient subgroups><patient subpopulations><patient subsets><patient subtypes><primary care clinic><primary care clinician><primary care health service><primary care practice><primary care setting><primary health service><primary outcome><programs><psychologic><psychological><psychosocial><racial diversity><racial minority><racially diverse><randomized, clinical trials><reach, efficacy, adoption, implementation, and maintenance><recruit><risk stratification><safety net><satisfaction><screening><screenings><secondary cancer><secondary outcome><sedentary activity><service availability><services research><side effect><social><standard of care><stratify risk><study design><survivorship><technology implementation><technology validation><therapeutic efficacy><therapy efficacy><tool><treatment access><trial design><web><world wide web><≥65 years>