Developing a “toolkit” to measure implementation of concurrent palliative care in rural community cancer centers

Zubkoff, Lisa; Dionne‐Odom, J. Nicholas; Pisu, Maria; Babu, Dilip; Akyar, İmatullah; Smith, Tom E. C.; Mancarella, G.; Gansauer, Lucy; Sullivan, Margaret M.; Swetz, Keith M.; Azuero, Andres; Bakitas, Marie

doi:10.1017/s1478951517000323

Cited by 13 publications

(24 citation statements)

References 44 publications

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“…The evolution of the original ENABLE approach based on patient and family feedback, modified for cancer family caregivers and patients with HF and their family caregivers and ultimately tailored for rural underserved family caregivers is illustrated in Figure 1. After a successful implementation science pilot trial in cancer (Zubkoff et al, 2017), two strategies (virtual learning collaborative and technical assistance) are now being tested in a cluster-randomized trial within the National Community Oncology Research Group (NCORP) to discover the best way to integrate the ENABLE model into community oncology practices.…”

Section: Telehealth Examples From Research and Clinical Practicementioning

confidence: 99%

Can you hear me now?: Improving palliative care access through telehealth

Watts

Malone

Dionne-Odom

et al. 2021

Research in Nursing & Health

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Telehealth has been increasingly used to expand healthcare access over the last two decades. However, this had not been the case for palliative care (PC), because telehealth was considered nontraditional and impractical due to the sensitive nature of conversations and a "high touch" philosophy. Motivated by limited PC access to rural and underserved populations and positive PC telehealth studies, clinical PC telehealth models have been developing. However, nearly overnight, the COVID-19 pandemic accelerated the use and uptake of telehealth across health care and especially in PC. As a result, clinicians, administrators, and others agree that telehealth is "here to stay," and will likely maintain widespread use and refinement beyond rural areas. The purpose of this review is to describe exemplar PC telehealth programs in research and clinical practice, including pros and cons, lessons learned, and future directions for the ongoing development and expansion of PC via telehealth across diseases and the lifespan.

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Section: Telehealth Examples From Research and Clinical Practicementioning

confidence: 99%

Can you hear me now?: Improving palliative care access through telehealth

Watts

Malone

Dionne-Odom

et al. 2021

Research in Nursing & Health

View full text Add to dashboard Cite

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“…The nurses felt that to continue the project they would need a semi-private space to make the calls and an adjusted workload that reflects the shared priority for this intervention. Other implementation studies of ENABLE likewise indicate that identifying dedicated personnel with adjusted workloads is an important facilitator of successful implementation (Zubkoff et al, 2018). Streamlined documentation (e.g., checkboxes as opposed to free text) may also be required, as the nurses had a difficult time documenting the strategies recommended and used.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy

et al. 2019

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Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions ( SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.

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“…This outcome will be measured for each practice cluster via phone interviews with Nurse Coaches and coordinators using the ENABLE General Organizational Index (GOI). This instrument was developed to assess factors that influence institutional implementation of the EN-ABLE program [38]. We previously adapted [38] the…”

Section: Aim 2: Overall Enable Program Implementation (Service Outcommentioning

confidence: 99%

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

et al. 2021

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Background Virtual Learning Collaboratives (VLC), learning communities focused on a common purpose, are used frequently in healthcare settings to implement best practices. Yet, there is limited research testing the effectiveness of this approach compared to other implementation strategies. This study evaluates the effectiveness of a VLC compared to Technical Assistance (TA) among community oncology practices implementing ENABLE (Educate, Nurture, Advise, Before Life Ends), an evidence-based, early palliative care telehealth, psycho-educational intervention for patients with newly diagnosed advanced cancer and their caregivers. Methods Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Proctor’s Implementation Outcomes Frameworks, this two-arm hybrid type-III cluster-randomized controlled trial (RCT) will compare two implementation strategies, VLC versus TA, among the 48 National Cancer Institute Community Oncology Research Program (NCORP) practice clusters that have not historically provided palliative care to all patients with advanced cancer. Three cohorts of practice clusters will be randomized to the study arms. Each practice cluster will recruit 15–27 patients and a family caregiver to participate in ENABLE. The primary study outcome is ENABLE uptake (patient level), i.e., the proportion of eligible patients who complete the ENABLE program (receive a palliative care assessment and complete the six ENABLE sessions over 12 weeks). The secondary outcome is overall program implementation (practice cluster level), as measured by the General Organizational Index at baseline, 6, and 12 months. Exploratory aims assess patient and caregiver mood and quality of life outcomes at baseline, 12, and 24 weeks. Practice cluster randomization will seek to keep the proportion of rural practices, practice sizes, and minority patients seen within each practice balanced across the two study arms. Discussion This study will advance the field of implementation science by evaluating VLC effectiveness, a commonly used but understudied, implementation strategy. The study will advance the field of palliative care by building the capacity and infrastructure to implement an early palliative care program in community oncology practices. Trial registration Clinicaltrials.gov. NCT04062552; Pre-results. Registered: August 20, 2019. https://clinicaltrials.gov/ct2/show/NCT04062552?term=NCT04062552&draw=2&rank=1

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Developing a “toolkit” to measure implementation of concurrent palliative care in rural community cancer centers

Cited by 13 publications

References 44 publications

Can you hear me now?: Improving palliative care access through telehealth

Can you hear me now?: Improving palliative care access through telehealth

Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

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