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CDA 12-171 – HSR Study

CDA 12-171
Improving the prostate cancer survivorship care of veterans
Ted Albert Skolarus, MD MPH BS
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: December 2013 - November 2018
The burden of prostate cancer among Veterans is substantial with over 200,000 survivors and 12,000 new diagnoses annually. Most men live with rather than die from this common disease making prostate cancer survivorship care especially important. Because of its leadership in chronic disease care and the proportion of older men served, the Veterans Health Administration (VHA) is well positioned to become one of the national leaders in prostate cancer survivorship care.

However, the quality of Veteran prostate cancer survivorship care is largely unknown. In addition, there is poor consensus about whether primary care providers or cancer specialists should have primary responsibility for ongoing cancer surveillance and management of treatment-related side effects (e.g., incontinence, osteoporosis). Ultimately, the design and implementation of tools to optimize prostate cancer survivorship care rests upon understanding how responsibility for survivorship care is managed and the barriers to good survivorship care.

This research program will improve our understanding of Veteran prostate cancer survivorship care and seek to improve it using state-of-the-art implementation science methods. This program has three aims.

Aim 1: To examine variation in 2 key quality indicators of prostate cancer survivorship care. Using national VHA data (2005-2011), we will examine variation in the quality of prostate cancer survivorship care for cancer surveillance and bone density testing.

Aim 2: To assess barriers and facilitators to delivering high quality prostate cancer
survivorship care. Guided by theory, we will perform focus groups and interviews with primary care providers and prostate cancer specialists to better understand how to improve survivorship care.

Aim 3: To develop, implement and pilot a theory-based intervention to improve the
quality of prostate cancer survivorship care. We will use our findings to pilot an intervention that addresses quality gaps in cancer surveillance and bone density testing uncovered in Aim 1, in preparation for a randomized trial.

The goal of this research program is to better understand prostate cancer survivorship care in the VHA and to develop and pilot theory-informed interventions to improve the quality of care for Veteran cancer survivors. In the context of the VA Quality Enhancement Research Initiative (QUERI) framework, these research projects span 5 of the 6 developmental processes.

Project 1 studies the large-scale context of survivorship care and defines the magnitude of variations of several indicators that reflect prostate cancer survivorship care quality. We also assess the association of VHA prostate cancer specialist workforce on the quality of care, an important potential influence on the relationship between cancer specialists and primary care providers and their medical homes (QUERI 1-3). While the workforce likely influences survivorship care quality, a more nuanced approach will be needed to understand how it and other potential barriers (e.g., care coordination issues, knowledge gaps) impact the delivery of prostate cancer survivorship care. For this reason, in Project 2 we will use mixed methods approaches to assess the context of cancer survivorship care delivery across settings of variable quality while gathering valuable insights into the theoretical underpinnings of prostate cancer survivorship care focusing on cancer surveillance and bone density testing (QUERI 2,3). In Project 3, we will develop and implement theory-based interventions, developed from findings in Projects 1 and 2. These will include components like a video teleconferencing and education project to build primary care provider self-efficacy managing prostate cancer treatment side effects (QUERI 4, 5).

Not yet available.

Due to the expanding population of Veteran prostate cancer survivors, optimizing their quality of survivorship care is of the utmost importance. Our findings will inform models for cancer survivorship care across VHA and guide future implementation efforts to improve the quality of cancer care.

External Links for this Project

NIH Reporter

Grant Number: IK2HX001162-01

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None at this time.

DRA: Aging, Older Veterans' Health and Care, Health Systems, Cancer
DRE: Prevention, Prognosis, Technology Development and Assessment
Keywords: Career Development
MeSH Terms: none

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