The Optimizing Implementation in Cancer Control (OPTICC) Center

Abstract:

The next decade offers an unparalleled opportunity for implementation science (IS) to reduce cancer burden and health disparities for fifteen million people in the United States who will be diagnosed with cancer . Evidence-based interventions (EBIs) could reduce cervical cancer deaths by 90%, colorectal cancer deaths by 70%, and lung cancer deaths by 95% if widely and effectively implemented in clinical and community settings . Yet, EBI implementation, when it occurs, is often suboptimal. In “implementation as usual,” implementation strategies are neither matched to important contextual factors, nor operationalized to reflect best possible methods, given constraints.

IS can support EBI implementation by generating practical methods for assessing implementation context, prioritizing implementation barriers, and matching strategies to prioritized barriers. With these methods, implementers could optimize EBI implementation by applying the right strategies to high-priority barriers, thereby avoiding strategy-barrier mismatch. IS can also generate useful guidance on operationalizing strategies for optimal effectiveness, efficiency, or fit with local resources. Such guidance is lacking even for established strategies like audit and feedback, which can be operationalized in many ways (e.g., format and frequency ). For IS to support optimized EBI implementation, four critical barriers must be overcome: underdeveloped methods for barrier identification and prioritization , incomplete knowledge of strategy mechanisms (a requisite for strategy-barrier matching ); underutilization of methods for optimizing strategies ; and poor measurement of implementation constructs . Now is the time for IS to overcome these barriers and increase EBI implementation in cancer control. Speed is required or the opportunity improve the lives of millions of Americans will pass.

We propose to address the “grand challenge” of optimizing EBI implementation in cancer control by creating the OPTICC (Optimizing Implementation in Cancer Control) Center, a strategic collaboration of the University of Washington (UW), Kaiser Permanente Washington Research Institute (KPWHRI), and the Fred Hutchinson Cancer Research Center (FHCRC). The long-term goal is to improve cancer outcomes for all by supporting optimized EBI implementation for many cancers across the cancer care continuum. The objective is to develop, test, and refine innovative approaches for optimizing EBI implementation.

To address health equity, we will (1) test and refine these approaches in low-resource settings that serve racially and ethnically diverse, low-income populations; and (2) optimize strategies that address barriers that disadvantaged populations disproportionately experience. The rationale is that the grand challenge of optimizing EBI implementation can be met with greater impact and efficiency by supporting multiple, synergistic studies that address the four critical barriers using shared resources than by conducting individual studies in isolation.

The Center will pursue four specific aims:

• Aim 1: Advance IS in cancer control by conducting innovative studies to optimize EBI implementation.
• Aim 2: Improve measurement and methods in IS by developing and testing reliable, valid, pragmatic measures of implementation constructs and deploying and refining innovative approaches for optimizing strategies.
• Aim 3: Support a diverse implementation laboratory of clinical and community partners to conduct rapid, “in vivo” implementation studies anywhere along the cancer care continuum for a wide range of cancers.
• Aim 4: Build IS capacity in cancer control by training and supporting new investigators, engaging investigators established in other fields in cancer-focused IS, and contributing to a nationwide IS consortium.

Sponsor Award Number: 1P50CA244432-01