Pragmatic randomized trial of a distress screening program using an effectiveness-implementation hybrid design
| Autor: | Farah Brasfield, Shannon La Cava, Lindsay Joe Lyons, Michael K. Gould, Erin Elizabeth Hahn, Corrine Munoz-Plaza, Lara N. Durna, Alexander Ferreira, Joanne E. Schottinger, Brian S. Mittman, Karen W. Kwan, Ernest Shen, Dana Pounds, Janet S. Lee, David B. Beard |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 37:5-5 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2019.37.27_suppl.5 |
| Popis: | 5 Background: Implementation of guideline-recommended distress screening in oncology remains challenging. Evidence suggests that multicomponent care pathways to identify distress severity with algorithm-based referral and management are effective, yet testing of pragmatic implementation in community settings remains limited. We conducted a pragmatic randomized trial of a distress screening program in a large healthcare system to evaluate effectiveness and simultaneously examined implementation outcomes. Methods: We designed a highly pragmatic study per the Pragmatic-Explanatory Continuum Indicator Summary-2 with adaptive workflow design. Randomization was at the medical center level (N=6); eligible patients had a new diagnosis of breast cancer (no exclusions). Eligible patients were offered the distress screening program as part of usual care: PHQ-9 screening, algorithm-based scoring and referral, referral tracking, and audit and feedback of performance data. Control sites had access to the PHQ-9 and scoring algorithm. We compared number screened, distress severity, and referral. We conducted qualitative interviews with stakeholders on implementation barriers and facilitators. Results: We enrolled 1,436 eligible patients; 692 control, 744 intervention. Groups were similar in demographic and tumor characteristics (Table); 80% of patients completed screening at intervention sites vs [Table: see text] |
| Databáze: | OpenAIRE |
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