Partnering with primary care to address goals of equity, value and sustainment for primary cancer prevention - PROJECT SUMMARY/ABSTRACT
Rural-serving primary care clinics in our Colorado Implementation Science Center in Cancer Control (COISC3)
seek to address inequities in behavioral cancer risks and unmet social needs. Clinics need efficient, low-cost
tools to screen for and address multiple risks at the same time — and technology can provide important
efficiencies. My Own Health Report (MOHR) is a web-based intervention with 3 core functions: 1) Risk
Flagging; 2) Goal-setting for patient-prioritized risks; 3) Service Linkage to resources. Our prior trial found that
patients receiving MOHR improved physical activity (p < 0.001) and diet (p < 0.001) behaviors that increase
the risk for many types of cancer; MOHR also showed improvements in other health behaviors and a signal of
reduced tobacco use (with a small n). Thus, MOHR has great potential to prevent cancer. However, we
identified two key gaps. First, our COISC3 clinics voiced a need for a more flexible menu of delivery options to
feasibly adopt and sustain the intervention. Second, to achieve equitable reach and effectiveness, particularly
for those with unmet social needs, clinics need to provide structured follow-up. Such follow-up increases
patient access to resources for behavioral risks and/or unmet social needs, thus “leveling the playing field” to
address cancer risks. Our new preliminary data show clinics and patients value MOHR with structured follow-
up strategies to remind patients of their goals and to provide relevant resources. We developed the
infrastructure for and pilot-tested two distinct implementation strategy bundles to provide this follow-up. The
first bundle, termed “Reminder-Resource message (R2 message),” involves electronic texts/e-mails sent
automatically by MOHR. The second bundle, “R2 Navigation,” trains staff in each clinic to personally deliver
these reminders and resources. Each strategy bundle addresses the contextual determinants of successful
implementation and sustainment identified in our Pragmatic Robust Implementation and Sustainability Model
(PRISM). However, the relative impact of R2 message, R2 Navigation, or their combination is unknown. In Aim
1, we will engage staff, patients, and partners in our COISC3 to finalize the implementation plans to deliver R2
message and R2 Navigation from a menu of options co-developed in preliminary workshops. In Aim 2, we will
conduct a randomized comparative effectiveness-implementation trial with 1,400 adult patients with two or
more cancer risks (including both insufficient physical activity and fruit/vegetable intake) across 7 COISC3
clinics to evaluate the comparative outcomes of R2 message and R2 Navigation alone or in combination. We
will assess multi-level outcomes, including: 1) Effectiveness, 2) Implementation, and 3) Practice Value
(including patient experience and costs). In Aim 3, we will use our iterative PRISM process to co-develop an
“implementation, adaptation and sustainment guide” for the most cost-effective implementation strategy
identified in Aim 2. Overall, we expect to reduce multiple cancer risks equitably, in part by addressing unmet
social needs, and to improve outcomes important to patients, primary care, and society.
