ActivityChoice: A clinic-delivered implementation program to increase physical activity and decrease cardiovascular disease risk amongst cancer survivors - PROJECT SUMMARY Cancer survivors have 1.7-18.5-fold increased risk, and 1.3-3.6-fold increased mortality of cardiovascular disease (CVD). Physical activity has been shown to ameliorate risk, but survivors’ levels are far below the general population. Due to this, provider physical activity recommendations and referrals are recommended by the Institute of Medicine and the American Heart Association in survivorship care plans. In light of these recommendations, barriers to physical activity participation among survivors exist at the provider, community, and survivor levels. There is a critical need for implementation programs to connect these resources to increase physical activity among survivors. To address this need, I developed, and beta tested a clinic-based eReferral system referring patients to a nationwide community-based group program, LIVESTRONG at the Y, for survivors. Due to COVID-19, we also referred to a virtual group program, Fit Cancer. The beta-test revealed the potential of this approach; providers were engaged and referred survivors to the physical activity programs. It also revealed the need for the eReferral to provide physical activity program choices, including a non-group self- monitored digital health program. We, therefore, will build on the prior eReferral to develop and test ActivityChoice in this 4-year proposal. ActivityChoice will include a patient narrative decision aid to support choices to three evidence-based programs: LIVESTRONG (group in-person), Fit Cancer (group virtual), and CareEvolution (Fitbit activity tracking and tailored messaging digital health). We found survivors prefer to hear personal stories and support from other survivors to help support activity adoption, thus our decision aid will include patient narrative stories to support program choices. In Aim 1, we will develop and test patient decision aids to support choices with survivors and clinic staff and refine ActivityChoice. In Aim 2, we will conduct a stepped wedge trial with clinic staff (n=8) at 3 UMass Cancer clinics sites, comparing an enhanced standard of care control to the ActivityChoice implementation program in 70 patients with survivorship care planning visits. We hypothesize ActivityChoice will have greater referral rates as compared to the enhanced standard of care control. We will assess additional implementation outcomes, as well as exploratory physical activity and patient- reported outcomes. In Aim 3, we will refine ActivityChoice and prepare for a multi-site trial through interviews with stakeholders (survivors, clinic staff and administration) and potential future sites identified through our collaborative networks. The refined program will be tested in a fully-powered effectiveness R01 trial submitted in Year 4 of this project. To accomplish these aims, I will be guided by expert mentors and receive specialized training in 1) Health and patient-provider communication, 2) Digital Health, 3) Advanced pragmatic clinical trials and 4) Leadership and grant-development. This project will be conducted in collaboration with our clinical, community and patient partners (Community Advisory Board) to guide the overall project design.
