Implementation of Comprehensive Survivorship Care Intervention Across FQHC-Based Primary Care Practices - 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.
