Project ADAPT: Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care: A Study Design (Preprint)

BACKGROUND Metastatic breast cancer (MBC) remains incurable despite significant treatment advances. Coordinating care for patients with MBC can be challenging given the various treatment options, available clinical trials, and frequent need for ancillary services. To optimize the care of those with MBC, we designed an academic and community practice collaborative care model based on the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program developed at the Dana Farber Cancer Institute entitled Project ADAPT. OBJECTIVE To describe the implementation science-based study design and innovative components of Project ADAPT. METHODS Project ADAPT utilizes the Dynamic Adaptation Process informed by the Exploration, Preparation, Implementation, and Sustainment framework. Washington University School of Medicine (WUSM) partnered with three community hospitals in the St. Louis region covering rural and urban settings. The Exploration and Preparation phases provide patient and provider feedback on current referral practices to finalize the approach for the Implementation phase. At the Implementation phase, we will enroll patients with MBC at these three community sites to evaluate potential collaborative care at WUSM and assess the impact of this collaborative care model on referral satisfaction and acceptability for patients with MBC and their providers. Patients may then return to their community site for care or continue to receive part of their care at WUSM. We are incorporating virtual and digital health strategies in our approach to improving MBC care coordination to minimize the patient burden. RESULTS The Exploration phase is ongoing. As of August 2021, we have recruited 21 patient and provider participants to complete surveys of the current collaborative care process at WUSM. Throughout this phase and in preparation for the Implementation phase, we have iteratively updated and refined our surveys for the Implementation phase based on testing of our data collection instruments. Our partner sites are in various stages of the single Institutional Review Board (IRB) approval process, which involves a signed reliance agreement between the institutions as well as a site registration and study application process. We have ongoing engagement with all partner sites, which helped solidify our participant recruitment strategies and design patient-friendly recruitment materials. In addition, we have included a patient advocate on the research team. Members of the research team have launched a single IRB Support Network at WUSM to create a repository of the single IRB procedures to streamline partner sites’ onboarding process and facilitate enhanced collaboration across institutions. CONCLUSIONS With this robust model, we expect that patients with MBC will receive optimal care regardless of geographical location and will improve the patient and provider experiences when navigating the health systems