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Grant Details

Grant Number: 5R01CA229197-06 Interpret this number
Primary Investigator: Zubkoff, Lisa
Organization: University Of Alabama At Birmingham
Project Title: Implementing Palliative Care: Learning Collaborative Vs. Technical Assistance
Fiscal Year: 2023


Project Summary    The American Society of Clinical Oncology (ASCO) recommends “…combined standard oncology care and  palliative care…early in the course of illness for any patient with metastatic cancer and/or high symptom  burden”. Unfortunately, early palliative care is not routinely incorporated into treatment plans at the onset of  advanced diagnosis, thereby depriving patients of potential quality of life benefits, especially low access  populations including minorities and rural-­dwellers. The problem is that we do not know how to best assist  health systems wanting to integrate early palliative care services into their usual oncology care. Virtual  Learning Collaboratives (VLCs), comprised of multiple health systems that work together virtually to implement  an evidence-­based practice, offer a solution. VLC features include the formation of quality improvement teams,  group problem solving, and data reporting/feedback. Despite widespread use of VLCs in healthcare, few  studies have evaluated their effectiveness. To address this gap, we propose to test the effectiveness of a VLC  implementation strategy on integration of an evidenced-­based model of early concurrent oncology palliative  care called ENABLE (Educate, Nurture, Advise, Before Life Ends). ENABLE is the only evidence-­based,  scalable early palliative care model promoted by the National Cancer Institute (NCI) Research Tested  Intervention Program. Guided by the RE-­AIM framework and using Proctor’s Outcomes for Implementation  Research model, we propose a cluster-­randomized trial with 48 NCI Community Oncology Research Program  (NCORP) practices implementing ENABLE to evaluate the effectiveness of a Virtual Learning Collaborative  (VLC) compared to typical implementation consisting of limited technical assistance (TA). In this hybrid type III  design implementation effectiveness trial, we will compare two implementation strategies in real world  oncology practices to determine Implementation (ENABLE uptake), Service, and Patient outcomes. Study aims  are: 1) Compare the effectiveness of VLC vs. TA on ENABLE program uptake, measured as the proportion of  patients at participating NCORP practices who complete the ENABLE program;? 2) Compare the effectiveness  of VLC vs. TA on NCORP practices implementation teams’ fidelity to ENABLE and assigned implementation  strategy;? 3) Compare NCORP practices randomized to VLC or TA on patient and caregiver quality of life (QOL)  and mood outcomes;? and 4) Determine the relationship between ENABLE program uptake and fidelity and  patients’ QOL and mood across the two strategies. This research will impact public health by addressing a  knowledge gap on appropriate strategies to implement scalable evidence-­based palliative care practices while  reducing the disparity of sub-­optimal cancer care for advanced cancer patients.  


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.
Authors: Zubkoff L. , Lyons K.D. , Dionne-Odom J.N. , Hagley G. , Pisu M. , Azuero A. , Flannery M. , Taylor R. , Carpenter-Song E. , Mohile S. , et al. .
Source: Implementation science : IS, 2021-03-11; 16(1), p. 25.
EPub date: 2021-03-11.
PMID: 33706770
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Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis.
Authors: Schulman-Green D. , Feder S.L. , Dionne-Odom J.N. , Batten J. , En Long V.J. , Harris Y. , Wilpers A. , Wong T. , Whittemore R. .
Source: Journal of family nursing, 2021 Feb; 27(1), p. 55-72.
EPub date: 2020-12-17.
PMID: 33334232
Related Citations

Effect of instrumental support on distress among family caregivers: Findings from a nationally representative study.
Authors: Kent E.E. , Mollica M.A. , Dionne-Odom J.N. , Ferrer R.A. , Jensen R.E. , Ornstein K.A. , Smith A.W. .
Source: Palliative & supportive care, 2020 Oct; 18(5), p. 519-527.
PMID: 32090725
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Update in Hospice and Palliative Care.
Authors: Hyden K. , Gelfman L. , Dionne-Odom J.N. , Smith C.B. , Coats H. .
Source: Journal of palliative medicine, 2020 Feb; 23(2), p. 165-170.
EPub date: 2019-12-05.
PMID: 31808708
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Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia.
Authors: Dionne-Odom J.N. , Currie E.R. , Johnston E.E. , Rosenberg A.R. .
Source: Seminars in oncology nursing, 2019 Dec; 35(6), p. 150954.
EPub date: 2019-11-18.
PMID: 31753704
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What do family caregivers know about palliative care? Results from a national survey.
Authors: Dionne-Odom J.N. , Ornstein K.A. , Kent E.E. .
Source: Palliative & supportive care, 2019 Dec; 17(6), p. 643-649.
PMID: 30957733
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Update in Hospice and Palliative Care.
Authors: Mather H.L. , Coats H. , Desanto K. , Dionne-Odom J.N. , Smith C.B. , Gelfman L.P. .
Source: Journal of palliative medicine, 2019 Apr; 22(4), p. 357-363.
PMID: 30933568
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