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Rao M, Densley S, Marciniak A, Burgoa S, Zerrouki Y, Okwaraji G, Lobaina D, Jhumkhawala V, Knecht M, Kitsantas P, Sacca L. Dissemination and implementation science frameworks and strategies to increase breast cancer screening for at-risk women in the United States: A scoping review. J Public Health Res 2024; 13:22799036241268841. [PMID: 39119619 PMCID: PMC11304495 DOI: 10.1177/22799036241268841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Dissemination and implementation science (D&I) can help bridge the gap between research and practice by addressing how to facilitate and maintain pre-existing evidence-based interventions (EBIs) in various contexts within different fields, including that of breast cancer screening and treatment. Yet, despite the availability of D&I frameworks and strategies, there is a lack of studies exploring knowledge transfer dissemination and implementation models, strategies, and frameworks in the setting of breast cancer care. There is a need for studies that create guidelines and roadmaps built on theoretical foundations of D&I research to scale up successful D&I of strategies, frameworks, and protocols proven to cater to the needs of all breast cancer patients when seeking screening and treatment services. The Arksey and O'Malley (2005) York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. Most cited barriers (n = 46) sorted into the category of "Recruitment, Measurement, and Delivery Challenges." The predominant ERIC strategy, featured in a noteworthy 84% of studies, was "Tailor strategies" (#16), which belongs to the "Adapt and tailor to context: culture, language, data analysis, collection" domain. This study can guide researchers, physicians, and community workers in improving accessibility, affordability, and quality of breast cancer screening and adequate follow-up opportunities through D&I strategies and models improving the reach and sustainability of evidence-based programs in at-risk female populations.
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Affiliation(s)
- Meera Rao
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sebastian Densley
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Adeife Marciniak
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Yasmine Zerrouki
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Goodness Okwaraji
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michelle Knecht
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Panagiota Kitsantas
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Lea Sacca
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Ginzberg SP, Edmonds CE, Dako F, Donnell T, Washington AL, Elmore LC, Lee DJ, Vachani A, Mincarelli D, Zeballos Torrez C, McCormick TM, Rodriguez V, Nguyen V, Oliva C, Atherholt B, Gaiser R, Congiu L, Grant B, Gungor M, Englander BS, Guerra CE, Nunes LW. Together We Go Farther: Improving Access to Cancer Screening Through a Multidisciplinary, One-Stop-Shop Approach. Acad Radiol 2023; 30:3153-3161. [PMID: 37714719 DOI: 10.1016/j.acra.2023.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 09/17/2023]
Abstract
RATIONALE AND OBJECTIVES Despite significant scientific advances in cancer treatment in recent decades, Black Americans still face marked inequities in cancer screening, diagnosis, and treatment. Redressing these persistent inequities will require innovative strategies for community engagement. Radiologists, as experts in cancer screening and diagnosis for multiple malignancies, including breast, lung, and colon, are ideally suited to lead and implement community-based strategies to address local cancer disparities. MATERIALS AND METHODS Through an established academic-community partnership in West Philadelphia built over the course of multiple prior community healthcare events, the authors piloted a novel radiology-led multidisciplinary approach to improve access to cancer screening for the predominantly Black, medically-underserved residents. Using a "one-stop-shop" framework to provide a comprehensive suite of screening and ancillary services in the heart of the community, the authors sought to remove as many impediments to screening as possible. RESULTS Approximately 350 participants attended the health fair, and a total of 232 screening tests or assessments were completed. Data from this event suggest that this inclusive approach, as well as the use of a health fair "passport" to incentivize engagement, can successfully improve access to screening and follow-up in an underserved community. CONCLUSION This "one-stop-shop" community approach can be replicated by radiology-led teams in other settings as a high-value, scalable opportunity to reduce disparities in access to cancer screening.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., L.C.E., D.J.L.); Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Christine E Edmonds
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.); Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.).
| | - Farouk Dako
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | | | - Armenta L Washington
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Leisha C Elmore
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., L.C.E., D.J.L.); Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Daniel J Lee
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., L.C.E., D.J.L.); Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Anil Vachani
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.); Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania (A.V., C.E.G.)
| | - Deborah Mincarelli
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania (D.M.)
| | - Carla Zeballos Torrez
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | - Thomas M McCormick
- Patient Accounting, University of Pennsylvania Health System, Philadelphia, Pennsylvania (T.M.M.)
| | - Veronica Rodriguez
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Vivian Nguyen
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.)
| | - Catherine Oliva
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | - Barbara Atherholt
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | - Raymond Gaiser
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | - Lawrence Congiu
- Information Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania (L.C.)
| | - Brandon Grant
- Office of the Chief Executive Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania (B.G.)
| | - Murat Gungor
- Senior Vice President of Diagnostic Imaging, Siemens Healthineers, Malvern, Pennsylvania (M.G.)
| | - Brian S Englander
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
| | - Carmen E Guerra
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (S.P.G., C.E.E., A.L.W., L.C.E., D.J.L., A.V., V.R., V.N., C.E.G.); Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania (A.V., C.E.G.)
| | - Linda W Nunes
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.E.E., F.D., C.Z.T., C.O., B.A., R.G., B.S.E., L.W.N.)
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Chan RJ, Milch VE, Crawford-Williams F, Agbejule OA, Joseph R, Johal J, Dick N, Wallen MP, Ratcliffe J, Agarwal A, Nekhlyudov L, Tieu M, Al-Momani M, Turnbull S, Sathiaraj R, Keefe D, Hart NH. Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA Cancer J Clin 2023; 73:565-589. [PMID: 37358040 DOI: 10.3322/caac.21788] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 06/27/2023] Open
Abstract
Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vivienne E Milch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narayanee Dick
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anupriya Agarwal
- Cancer Australia, Sydney, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Human Performance Research Centre, Innovative Solutions for Well-being and Health (INSIGHT) Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
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Pratt-Chapman ML, Silber R, Tang J, Le PTD. Implementation factors for patient navigation program success: a qualitative study. Implement Sci Commun 2021; 2:141. [PMID: 34930503 PMCID: PMC8685795 DOI: 10.1186/s43058-021-00248-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patient navigation (PN) is an evidence-based practice that involves assessing and addressing individual barriers to care for patients. While PN has shown effectiveness in numerous studies, designing successful, sustainable PN programs has remained challenging for many healthcare organizations. The purpose of the present study was to examine implementation factors for successful PN programs to optimize the sustainability of PN services across cancer care settings in the USA. METHODS Data were collected via semi-structured interviews with PN stakeholders (n=17) from diverse cancer care settings. Thematic content analysis was conducted by deductively coding major themes based on constructs from the Exploration-Preparation-Implementation-Sustainability framework and by inductively coding emergent themes. RESULTS Facilitators in the outer context included payer guidelines, accreditation requirements, community partnerships, and demonstrated need and demand for services. Inner context factors such as alignment with organizational and leadership priorities, appropriate staff support and workloads, and relative advantage were important to program success. Innovation characteristics such as the presence of innovation champions, clear role and scope of practice, clear protocols, strong communication channels, and innovation fit were facilitators of program success. Community-Academic partnerships and funding stability also emerged as facilitators for program sustainability. CONCLUSION Our qualitative analysis from a diverse sample of PN stakeholders and programs across the USA supports intentional use of implementation theory to design PN programs to optimize implementation success.
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Affiliation(s)
- Mandi L Pratt-Chapman
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
| | - Rachel Silber
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jeffrey Tang
- Graduate School of Arts and Sciences, New York University, New York, USA
| | - Phuong Thao D Le
- School of Global Public Health, New York University, New York, NY, USA
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