Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

Battaglia, Tracy A.; Freund, Karen M.; Haas, Jennifer S.; Casanova, Nicole; Bak, Sharon; Cabral, Howard; Freedman, Rachel A.; White, Karen Burns; Lemon, Stephenie C.

doi:10.1016/j.cct.2020.106007

Cited by 21 publications

(23 citation statements)

References 27 publications

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“…Translating Research Into Practice (TRIP) is a clusterrandomized, stepped-wedge hybrid type I effectivenessimplementation trial, launched in 2018 across six breast cancer care clinics. Details of the TRIP study design and intervention have been published elsewhere [21]. The TRIP study is designed to evaluate the impact of a multilevel patient navigation intervention on timely, quality breast cancer care, with implementation data providing context to our main clinical outcome.…”

Section: Settingmentioning

confidence: 99%

Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

Loo

Mullikin

Robbins

et al. 2022

BMC Health Serv Res

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Background In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation. Methods We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR. Results Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority). Conclusions Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators’ patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload. Trial registration Clinical Trial Registration Number NCT03514433, 5/2/2018.

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Section: Settingmentioning

confidence: 99%

Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

Loo

Mullikin

Robbins

et al. 2022

BMC Health Serv Res

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“…Suggestions provided by participants to improve integration and coordination included centralizing information about supportive care services, developing virtual/online/telehealth supportive care programming to minimize the need to travel/commute to the cancer centre to access in-person programming, having dedicated professional patient navigators/coaches, and a “one-stop-shop” to access supportive care. These strategies have already been implemented/tested in various ways at different cancer care institutions [ 20 , 21 , 22 , 23 , 24 ]. For example, centralizing information about supportive care services has been developed using eHealth (i.e., web-based Internet search engines or smartphone applications) [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“What We Want Is More Access…”: Experiences of Supportive Cancer Care and Strategies for Advancement in a Canadian Provincial Cancer Care Organization

et al. 2021

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Objectives: Despite calls for better supportive care, patients and families still commonly bear significant responsibility for managing the physical and mental health and social challenges of being diagnosed with and treated for cancer. As such, there is increased advocacy for integrated supportive care to ease the burden of this responsibility. The purpose of this study was to understand patient and caregiver experiences with supportive care to advance its delivery at a large provincial cancer care organization in Canada. Method: We used a qualitative descriptive approach to analyze focus groups with patients and caregivers from seven sites across the large provincial cancer care organization. Results: Focus group participants (n = 69) included cancer patients (n = 57) and caregivers (n = 12). Participants highlighted positive and negative aspects of their experience and strategies for improvement. These are depicted in three themes: (1) improving patient and provider awareness of services; (2) increasing access; (3) enhancing coordination and integration. Participants’ specific suggestions included centralizing relevant information about services, implementing a coach or navigator to help advocate for access, and delivering care virtually. Conclusions: Participants highlighted barriers to access and made suggestions for improving supportive care that they believed would reduce the burden associated with trying to manage their cancer journey.

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“…TRIP is a hybrid, type I effectiveness-implementation trial that deploys a standardized patient navigation intervention across 6 Boston academic medical centers to address racial and socioeconomic disparities in receipt Cancer July 1, 2022 of timely breast cancer treatment. 13 The collaborative, systems-level intervention incorporates a citywide patient navigation protocol, the use of a shared regional patient registry, and a standardized assessment and referral process for addressing patients' barriers to care.…”

Section: Translating Research Into Practicementioning

confidence: 99%

Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

Casanova

LeClair

Xiao

et al. 2022

Cancer

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and the Translating Research Into Practice (TRIP) Consortium BACKGROUND: Implementing city-wide patient navigation processes that support patients across the continuum of cancer care is impeded by a lack of standardized tools to integrate workflows and reduce gaps in care. The authors present an actionable workflow process mapping protocol for navigation process planning and improvement based on methods developed for the Translating Research Into Practice study. METHODS: Key stakeholders at each study site were identified through existing community partnerships, and data on each site's navigation processes were collected using mixed methods through a series of team meetings. The authors used Health Quality Ontario's Quality Improvement Guide, service design principles, and key stakeholder input to map the collected data onto a template structured according to the case-management model. RESULTS: Data collection and process mapping exercises resulted in a 10-step protocol that includes: 1) workflow mapping procedures to guide data collection on the series of activities performed by health care personnel that comprise a patient's navigation experience, 2) a site survey to assess program characteristics, 3) a semistructured interview guide to assess care coordination workflows, 4) a site-level swim lane workflow process mapping template, and 5) a regional high-level process mapping template to aggregate data from multiple site-level process maps. CONCLUSIONS: This iterative, participatory approach to data collection and process mapping can be used by improvement teams to streamline care coordination, ultimately improving the design and delivery of an evidence-based navigation model that spans multiple treatment modalities and multiple health systems in a metropolitan area. This protocol is presented as an actionable toolkit so the work may be replicated to support other qualityimprovement initiatives and efforts to design truly patient-centered breast cancer treatment experiences.

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Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

Cited by 21 publications

References 27 publications

Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

“What We Want Is More Access…”: Experiences of Supportive Cancer Care and Strategies for Advancement in a Canadian Provincial Cancer Care Organization

Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

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