KanSurvive 2.0

Project Summary/Abstract Cancer survivors require long-term and coordinated care to address the physical, emotional, and psychosocial effects of cancer and its treatment. Rural cancer survivors are disproportionately affected by chronic illness and face a higher risk of negative health outcomes. Primary care providers (PCPs) recognize the importance of

delivering evidence-based practice (EBP) cancer survivorship care and are well-positioned to provide comprehensive and coordinated care, however, the needs of cancer survivors are frequently unmet, and providersdescribe limitations in knowledge of risk-based surveillance, long-term effects of cancer treatment

and their management, inadequate resources, and growing administrative demands as barriers to improving survivorship care. The overall goal of this project is to test the effectiveness of pragmatic strategies to promote high quality, evidence-based guideline concordant care for rural adult cancer survivors in primary care practice

utilizing tools from implementation science to gain a better understanding of the decision making and actions taken that facilitate or hinder implementation across multiple healthcare systems. To achieve this objective, we propose a three-arm cluster-randomized, multi-level intervention to provide education, tele-mentoring, and

whether 1) virtual scribes filling the role as trained medical assistants, 2) a team-based approach, 3) or usual care produces more guideline concordant cancer survivorship care. The primary outcome is practice level completion and documentation of cancer survivorship care as measured using a previously developed

composite scoring system that compares electronic health record (EHR) documented activity to National Comprehensive Cancer Network survivorship guidelines. The secondary outcome is to assess intervention sustainability of arm 1 and 2 activities at 12 and 24-months post implementation; measured as a function of

virtual scribe or team-based care actions to promote prior cancer diagnoses coding (ICD-10), use of EHR tools and health maintenance order sets and annual ordering of appropriate screenings for cancer survivors. Prior to implementation, formative evaluations will assess current systems of care and practice-level barriers and

facilitators for the delivery of EBP cancer survivorship care and inform modifications to implementation Guided by the Normalization Process Theory, we will examine agentic factors (e.g., actions taken/decisions made by the practice) to modify modes of care management and delivery. The RE-AIM evaluation framework will be used to explore potential population-level impact and generalizability of the

intervention in real-world clinical settings. strategies. The study will be conducted in 16 rural primary care practices in Kansas and was intentionally designed to bring care delivery changes into resource-limited practices and health systems. Results will add new evidence by informing pragmatic strategies to facilitate the adoption and

delivery of EBP cancer survivorship in rural primary care.