scholarly journals Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Janet A. Deatrick ◽  
Anne E. Kazak ◽  
Rebecca E. Madden ◽  
Glynnis A. McDonnell ◽  
Katherine Okonak ◽  
...  
Keyword(s):  
Health Equity ◽  
Pediatric Cancer ◽  
Universal Screening ◽  
Implementation Strategies ◽  
Interactive Systems ◽  
Psychosocial Risk ◽  
Care Providers ◽  
Psychosocial Screening ◽  
Universal Family ◽  
Key Stakeholders

Abstract Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020

scholarly journals Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial

2020 ◽  
Author(s):  
Anne Kazak ◽  
Janet Deatrick ◽  
Michele Scialla ◽  
Eric Sandler ◽  
Rebecca Madden ◽  
...  
Keyword(s):  
Pediatric Cancer ◽  
Comparative Effectiveness ◽  
Assessment Tool ◽  
Psychosocial Care ◽  
Implementation Strategies ◽  
Interactive Systems ◽  
Psychosocial Assessment ◽  
Use Of Resources ◽  
Healthcare Needs ◽  
Cluster Randomized

Abstract BackgroundChildhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g. economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.MethodThe PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation Strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when Training (Strategy I) is combined with Implementation Expanded Resources (Strategy II). There are three aims: 1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; 2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost effective use of resources consistent with family risk (institution); 3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit.DiscussionUse of the PAT across children’s cancer programs nationally can achieve the assessment Standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial RegistrationClinicalTrials.gov, NCT04446728, registered 23 June 2020

scholarly journals Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial

2020 ◽  
Author(s):  
Anne Kazak ◽  
Janet Deatrick ◽  
Michele Scialla ◽  
Eric Sandler ◽  
Rebecca Madden ◽  
...  
Keyword(s):  
Pediatric Cancer ◽  
Comparative Effectiveness ◽  
Assessment Tool ◽  
Psychosocial Care ◽  
Implementation Strategies ◽  
Interactive Systems ◽  
Psychosocial Assessment ◽  
Use Of Resources ◽  
Healthcare Needs ◽  
Cluster Randomized

Abstract Background: Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g. economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method: The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation Strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when Training (Strategy I) is combined with Implementation Expanded Resources (Strategy II). There are three aims: 1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; 2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost effective use of resources consistent with family risk (institution); 3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit. Discussion: Use of the PAT across children’s cancer programs nationally can achieve the assessment Standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial Registration: ClinicalTrials.gov, NCT04446728, registered 23 June 2020

Moving From Interprofessional Education Toward Interprofessional Practice: Bridging the Translation Gap

2019 ◽  
Vol 4 (5) ◽  
pp. 971-976
Author(s):  
Imran Musaji ◽  
Trisha Self ◽  
Karissa Marble-Flint ◽  
Ashwini Kanade
Keyword(s):  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Evaluation Model ◽  
Implementation Strategies ◽  
Future Research ◽  
Successful Implementation ◽  
Interprofessional Practice ◽  
Translational Model ◽  
Key Stakeholders ◽  
Clear Identification

Purpose The purpose of this article was to propose the use of a translational model as a tool for identifying limitations of current interprofessional education (IPE) research. Translational models allow researchers to clearly define next-step research needed to translate IPE to interprofessional practice (IPP). Method Key principles, goals, and limitations of current IPE research are reviewed. A popular IPE evaluation model is examined through the lens of implementation research. The authors propose a new translational model that more clearly illustrates translational gaps that can be used to direct future research. Next steps for translating IPE to IPP are discussed. Conclusion Comprehensive reviews of the literature show that the implementation strategies adopted to date have fostered improved buy-in from key stakeholders, as evidenced by improved attitudes and perceptions toward interprofessional collaboration/practice. However, there is little evidence regarding successful implementation outcomes, such as changed clinician behaviors, changed organizational practices, or improved patient outcomes. The authors propose the use of an IPE to IPP translational model to facilitate clear identification of research gaps and to better identify future research targets.

scholarly journals VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

Stability and change in family psychosocial risk over 6 months in pediatric cancer and its association with medical and psychosocial healthcare utilization

2019 ◽  
Vol 67 (2) ◽  
Author(s):  
Anne E. Kazak ◽  
Fang Fang Chen ◽  
Wei‐Ting Hwang ◽  
Martha A. Askins ◽  
Gabriela Vega ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Pediatric Cancer ◽  
Psychosocial Risk ◽  
Stability And Change

scholarly journals Screening for Family Psychosocial Risk in Pediatric Cancer: Validation of the Psychosocial Assessment Tool (PAT) Version 3

2018 ◽  
Vol 43 (7) ◽  
pp. 737-748 ◽  
Author(s):  
Anne E Kazak ◽  
Wei-Ting Hwang ◽  
Fang Fang Chen ◽  
Martha A Askins ◽  
Olivia Carlson ◽  
...  
Keyword(s):  
Pediatric Cancer ◽  
Assessment Tool ◽  
Psychosocial Risk ◽  
Psychosocial Assessment

scholarly journals Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Lianne Jeffs ◽  
Trevor Jamieson ◽  
Marianne Saragosa ◽  
Geetha Mukerji ◽  
Arsh K Jain ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Health Care Providers ◽  
Decision Makers ◽  
Care Providers ◽  
Factors Influencing ◽  
Virtual Care ◽  
Key Stakeholders ◽  
Hands On ◽  
Semistructured Interviews ◽  
At Home

BACKGROUND Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. OBJECTIVE In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. METHODS This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. RESULTS The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. CONCLUSIONS Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.

scholarly journals Is Long-Term Care Person Centred? A Case Study

2021 ◽  
Author(s):  
Katarina Young
Keyword(s):  
Long Term Care ◽  
Direct Care ◽  
Care Providers ◽  
Term Care ◽  
Study Approach ◽  
Key Stakeholders ◽  
Direct Care Providers ◽  
Government Legislation

In Ontario long-term care (LTC) settings, person-centred care (PCC) is promoted by government legislation, accreditation organizations and professional practice guidelines aiming to integrate this approach. However, there is currently no standardized approach to providing PCC in LTC. The purpose of this study was to examine public policies on PCC in Ontario and explore how they are interpreted and translated into practice in LTC. A qualitative case study approach was used to examine the perspectives of key stakeholders at one LTC facility in Ontario. Focus groups were conducted with residents, family members, direct care providers and managers. Through content analysis, findings were organized into four categories showcasing both overlapping and differential understandings of PCC in practice: 1) conceptualization, 2) barriers, 3) facilitators, and 4) evaluation. Identified tensions between policy and the delivery of PCC highlight systemic issues that must be addressed to enable equitable person-centred LTC rooted in resident-identified priorities.

scholarly journals Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

2021 ◽  
Vol 2 ◽  
pp. 263348952110494
Author(s):  
Rachel C. Shelton ◽  
Prajakta Adsul ◽  
April Oh ◽  
Nathalie Moise ◽  
Derek M. Griffith
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Health Inequities ◽  
Evidence Based ◽  
Racial Equity ◽  
Structural Racism ◽  
Core Elements ◽  
Evaluation Approaches

Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.

Identifying Strategies for Robust Survivorship Program Implementation: A Qualitative Analysis of Cancer Programs

2021 ◽  
Author(s):  
Soohyun Hwang ◽  
Burcu Bozkurt ◽  
Tamara Huson ◽  
Sarah Asad ◽  
Lauren Richardson ◽  
...  
Keyword(s):  
Program Implementation ◽  
Health Care Professionals ◽  
Implementation Strategies ◽  
The United States ◽  
Survivorship Care ◽  
Team Members ◽  
Care Plans ◽  
Care Processes ◽  
Key Stakeholders ◽  
Template Analysis

PURPOSE The Commission on Cancer seeks to promote robust survivorship programs among accredited cancer programs. In practice, cancer programs' survivorship programs range from cursory (eg, developing care plans without robust services) to robust (eg, facilitating follow-up care). To inform cancer programs' future efforts, in this study, we identified the implementation strategies that cancer programs used to achieve robust survivorship programs, distinguishing them from cursory programs. METHODS We sampled 39 cancer programs across the United States with approaches to survivorship program implementation ranging from cursory to robust on the basis of LIVESTRONG survivorship care consensus elements. Within sampled cancer programs, we conducted in-depth semistructured interviews with a total of 42 health care professionals. We used template analysis to distinguish implementation strategies used in cancer programs with robust survivorship programs from strategies that yielded cursory survivorship programs. RESULTS Cancer programs with robust survivorship programs established clear systems survivorship care and formal committees to improve the survivorship care processes. They sought buy-in from multiple stakeholders to leverage cancer program resources and defined clear roles with shared accountability among multidisciplinary groups. By contrast, cancer programs with cursory survivorship programs reported less consistency in survivorship care processes and lacked buy-in from key stakeholders. They had limited resources, faced persistent structural concerns, and had insufficient clarity in roles among team members. CONCLUSION Accrediting bodies may consider incorporating the implementation strategies that robust survivorship programs have used as guidance for supporting cancer programs in operationalizing survivorship care and evaluating the use of these strategies during the accreditation and review process.

Sign in / Sign up

Export Citation Format

Share Document