Feasibility and Adaptation of an Evidence-Based Multilevel Intervention for Improving Timeliness of Lung Cancer Treatment - Project Summary/Abstract Delayed time to treatment is a key determinant of poor survival among patients with lung cancer. Factors that affect timeliness of lung cancer treatment are multilevel in nature. However, most interventions target only one level of influence. Existing evidence-based interventions (EBIs) that work in one setting may also fail to work in a different setting due to poor fit in the new setting or deviations from the original intervention. The goals of this proposed R03 study are to: 1) evaluate the feasibility of adopting, within West Virginia University Cancer Institute (WVUCI) Network, an evidence-based Veterans Health Administration (VHA) multilevel lung cancer care coordination intervention aimed at improving timeliness of lung cancer treatment and; 2) adapt the intervention, guided by the Planned Adaptation framework, to improve fit. WVUCI is a regional network of cancer centers affiliated with WVU Medicine Health, with facilities in West Virginia, Pennsylvania, and Maryland. Five sites are credentialed for clinical trials with the National Cancer Institute. Our specific aims are to: 1) conduct a survey of providers and leadership on acceptability, appropriateness, feasibility, and attitudes towards the EBI (Aim 1) which will inform questions posed in subsequent interviews to further probe on appropriateness, inner and outer contextual issues affecting fit and feasibility, and proposed adaptations to the EBI (Aim 2). This study employs a sequential explanatory mixed methods methodology with integration at the data collection (interview questions informed by survey results) and interpretation stages (weaving the narrative from the interview into survey results). The main innovation of the proposed project is the redesign of an evidence-based intervention (EBI) to adapt it to a new setting by applying the concept of fidelity to core function. The study is significant because more than half of patients diagnosed with lung cancer in West Virginia either do not receive any treatment or receive delayed treatment (>35 days after diagnosis). The WVUCI Network is the single largest network of cancer care centers that provides treatment to patients with lung cancer in West Virginia. Over 800 patients with lung cancer receive care across the network annually, accounting for nearly half of 2000 cases diagnosed with lung cancer every year across WV. A well-adapted evidence-based multilevel intervention has the potential to improve timeliness of lung cancer treatment for a significant number of patients in West Virginia.
