CPCRN Scholars Program

Abstract

• Background: The growing body of older cancer survivors necessitates the use of routine assessment of this population’s unique medical needs and health concerns. Comprehensive geriatric assessments (CGAs) help determine an older person’s functional capabilities as cancer care providers plan treatment and follow-up care. Despite recommendations for CGA utilization, there is a lack of research on the implementation of CGAs into primary and secondary care for aging cancer survivors.

• Project Objectives: To better understand the barriers and facilitators of geriatric assessment use and to identify training and support needs in the area of CGA implementation. Qualitative interview results are presented according to these four categories:(1) purpose and value of a CGA and how this is communicated to patients and families,(2) CGA administration logistics,(3) barriers and facilitators to CGA implementation (Tara)(4) implementation training preferences and needs (Rowena)

• Qualitative Interviews: Eight primary and oncology care providers, recruited through CPCRN partner listservs, participated in the study. Semi-structured interviews were conducted by the lead investigator (Dr. Daniela Friedman) to explore providers’ current knowledge and implementation of geriatric assessments in their clinics. Each interview was recorded and then, transcribed by a transcription service.

• Coding: De-identified interview transcripts were reviewed by the team of coders (i.e., Rowena and Tara) generated a list of categories that would comprise the codebook. Once the codebook was finalized, each of the coders proceeded to code two transcripts (eight total), using a semantic thematic analysis approach, to identify select themes within each category.

• Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities.

• Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.

Scholars' Experiences

Rowena’s Experience:

My experience as a CPCRN scholar has been absolutely wonderful. I liked how they laid out the dissemination and implementation lecture materials for us to access asynchronously with check-ins to help with accountability. Additionally, having the opportunity to network with varying levels of scientists at different stages and different spheres helped me connect with individuals.

Working on the project, especially with Dr. Friedman was such an exemplary experience of how to both provide support and how to create independence. Although I felt that I was a novice with qualitative research (had never done it before), the support and encouragement in a safe environment helped me build an understanding of how my research labs should be run in the future. Additionally, having other individuals to work with who were at different levels was great to hear their tips while also developing my skills.

I cannot say enough about the opportunities that CPCRN has provided from both personal and professional development. I look forward to staying connected with CPCRN via workgroups and connecting with individuals at conferences in the future!

Tara’s Experience:

Being a CPCRN scholar has played an important role in my academic and professional goals. As a graduate student and budding scientist interested in behavioral oncology research, I was interested in learning about Dissemination and Implementation Science specific to cancer prevention and control. I was thrilled to learn of and be accepted into the CPCRN scholars program where I had the opportunity to complete a structured curriculum on this exact topic. The asynchronous design of the curriculum made it easier to complete at my own rate. This was especially helpful as I was simultaneously completing course work and requirements for my graduate program. In addition, the program has afforded me many opportunities to work collaboratively with other researchers across multiple disciplines and to form professional collaborations, work on cross-site projects and papers and apply my knowledge of and further develop my skills in community engaged research methods. In particular, my experience of working on the CGA project with Dr. Friedman and the team was an invaluable experience for my professional growth. Through this project, I learned about different strategies of conducting qualitative coding of semi-structured interviews; a skill that I always wanted to develop. It also gave me the opportunity to see what it's like to conduct this research with a large team of scientists with varying expertise on the topic. It really put into perspective the importance of team science in this area of research. Moreover, the continued support by the CPCRN scholar organizers and scholar program activities including webinars and workshops have been instrumental in building my goals of an academic research career in cancer prevention and control. I am very grateful that I had the experience of being a CPCRN scholar and I am thrilled to continue to be a part of CPCRN and the many projects to come.

Abstract

Adult survivors of pediatric cancer (ASPC) are at high risk of developing adverse effects such as cardiovascular toxicities, subsequent cancers, and psychosocial issues. One major adverse effect occurring in the cancer survivorship population is financial toxicity. Financial toxicity refers to the negative economic effects of cancer treatment including medical expenses, out-of-pocket expenses, and income loss due to their cancer experience. In addition, ASPC undergo a stage of healthcare transition, where they transition from the pediatric care model to the adult care model. When transitioning, ASPC build their independence over their healthcare decisions including developing self-care skills for adulthood and understanding and executing medical and insurance decisions. The purpose of this study is to describe the financial challenges of ASPC who have transitioned from pediatric care to adult care and to explore the impact of financial toxicity among ASPC who have transitioned from pediatric care to adult medical care. This study uses a qualitative approach to understand views and perceptions of financial challenges and impact of cancer during the transition out of pediatric care. For the study, we will conduct semi-structured focus groups and interviews to promote interaction among participants and to gain an in-depth comprehension of the perspectives of the participants understanding and experience surrounding financial burdens in cancer.

Scholar's Experience

Malesa's Experience:

Being a part of the CPCRN Scholars Program has been an enriching experience, one that allowed me to develop my skills in dissemination and implementation sciences as my prior experience was mainly focused in clinical research. The program provided a well-planned curriculum for different tracks and included multiple modules and activities to reinforce the information. I am deeply grateful for the opportunity to join CPCRN as a doctoral student, as the program also provided unique opportunities to engage in interdisciplinary discussions, learn and collaborate from experts in the field, and be involved in projects to expand my understanding of D&I.

As a scholar, I was able to undertake a project focusing on financial toxicity for the AYA Interest Group. Dr. Overholser’s mentorship was instrumental in the development and execution of the project. She met with me on a bi-weekly basis with constructive feedback and provided me with opportunities to further my knowledge in Pediatric and AYA cancer population. As a novice in qualitative methods, Dr. Overholser shared her experience working on qualitative research, which allowed me to build an understanding of how to develop and implement qualitative projects and accelerated the financial toxicity project development.

Being a part of the Scholar Program and CPCRN has been a transformative experience, and I am excited to continue working with CPCRN as I continue my journey in the D&I field.

Abstract

My PhD research was part of the ACCHIVe project, a multiregional and multidisciplinary initiative (more information: ACCHIVe Project) led by Prof. Dr. Julia Bohlius. This project, in collaboration with the International epidemiological Databases to Evaluate AIDS (IeDEA) African region and international and national stakeholders, aimed to reduce inequities in cervical cancer morbidity and mortality by developing a Cervical Cancer Prevention and Care Cascade (The CCPC Cascade) framework and monitoring tool for cervical screening programmes in sub-Saharan Africa offered to women living with HIV. We employed a wide range of state-of-the art methods including systematic literature review, surveys, Delphi consensus process, record linkages and mixed methods with qualitative and quantitative components. My PhD research focused on Objective 1 of the ACCHIVe project: consolidating indicators for the CCPC Cascade through a Delphi consensus process and stakeholders’ meetings. I conducted a systematic literature review to extract and group relevant indicators grouping them into domains along the cervical cancer prevention and care continuum. From February 2021 to March 2022, we conducted a three-round online Delphi process with 106 experts in sub-Saharan Africa. Through iterative, anonymous rounds, participants adapted, rated, and ranked indicators, achieving consensus on five core and 12 optional indicators tailored for HIV clinics. These indicators aim to enhance data collection quality for decision-making and policy development, helping to uncover disparities and service gaps. Additionally, I led the project's communication and dissemination strategy, resulting in a policy brief for policymakers, a project brochure for the general public, and several social media campaigns.

Maša's Experience:

Skills gained through the CPCRN program: When I joined the CPCRN program, my knowledge in implementation science was very limited. During the program, I learned about the crucial components of implementation science grant proposals, various theories and frameworks, and how to measure implementation, context, process, and outcomes. We shared and exchanged must-read literature, experiences, ideas, and knowledge. We worked on personal projects and received personalized feedback. We also had the opportunity to join CPCRN working groups, which further expanded our connections and knowledge.

Experience in the Scholars Program: I was surprised to be the only non-US participant, as the program is open to participants from all over the world. Participating in this yearlong program helped me expand my understanding of implementation and dissemination science and how I can apply it to my PhD research and future projects. It also provided a great foundation for my next steps in implementation science. Afterward, I joined the European Implementation Collaborative (EIC) network, participated in my first European Implementation Event, joined the Early Career Implementation Professionals (ECIP), and completed a Certificate Program in Implementation Practice University of North Carolina at Chapel Hill (UNC). The CPCRN Scholars Program was truly a pivotal moment in my implementation science career. Even two years later, I continue to follow CPCRN activities and updates, inspired daily by the support CPCRN offers its members. I am especially grateful to the organization team for ensuring the program ran smoothly, providing strong support and helping me establish meaningful connections.