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.
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