Grant Number:	1UG3CA315306-01 Interpret this number
Primary Investigator:	Schnoll, Robert
Organization:	University Of Pennsylvania
Project Title:	Designing and Evaluating Multi-Level Implementation Strategies to Address Alcohol Use Within Oncology Care
Fiscal Year:	2026

Alcohol use is causally linked to cancer, and continued use after a cancer diagnosis reduces treatment efficacy and increases the risk for a recurrence, a second primary, and death. Unfortunately, one-half to three-quarters of cancer patients and survivors report any alcohol use and one-third of cancer patients and survivors report drinking that exceeds recommended guidelines. Evidence-based treatments for alcohol misuse include counseling and medications and the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model provides a framework for delivering alcohol treatment, particularly within medical settings. Yet remarkably few individuals who misuse alcohol receive evidence-based treatments for their drinking, with only ~8% of cancer survivors receiving SBIRT for alcohol use, highlighting the need for implementation science to address this practice gap. Barriers to the implementation of SBIRT for alcohol use include: system- (e.g., lack of EMR tools; inadequate leadership endorsement; over-reliance on clinicians); clinician- (e.g., lack of time and training; lack of knowledge of the harmful effects of alcohol and effective treatments); and patient- (e.g., lack of knowledge of the harmful effects of alcohol and effective treatments; concerns about clinician judgment and stigma) level factors. Further, efforts to test implementation strategies to increase use of SBIRT for alcohol misuse have: 1) rarely addressed patient-level barriers; 2) rarely tested clinician-level strategies aside from training; 3) rarely used randomized designs; 4) rarely used key adaptations to system-level implementation such as pre-screening for alcohol use and behavioral support; and, critically 5) not tested implementation strategies to promote SBIRT for alcohol use in oncology. Behavioral economics offers a model for addressing multi-level implementation barriers by identifying patient and clinician heuristics related to decision making and then using choice architecture – message framing and default options – to nudge patients and providers towards a desired decision. A substantial literature, including studies by our group to address practice gaps within oncology, shows the effectiveness of using behavioral economics to improve implementation. In this application, we propose mixed methods in the UG3 Phase to identify patient and clinician heuristics associated with SBIRT for alcohol use and then a pilot trial to test multi-level implementation strategies to increase SBIRT for alcohol use in oncology. Then, following digital integration of implementation strategies and refinement of methods, the UH3 Phase will involve a pragmatic stepped-wedge randomized trial with >250 clinicians and 3,000 patients to assess the effects of our multi-level implementation strategies on increasing the use of SBIRT for alcohol use across our cancer service line and patient and clinician variables related to SBIRT completion. Overall, this application is devised to address current gaps in the literature concerning the testing of implementation strategies to promote SBIRT for alcohol use and endeavors to develop a transportable, low cost, and effective implementation approach to transform how alcohol use is addressed in oncology to improve patient outcomes.





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