15 Practice

ATTACHMENT 15

Formative Research to Assess Factors Affecting the

Translation of Research into Cancer Care Practice

Dear Colleague in Cancer Care:

The National Cancer Institute (NCI) is actively working to improve the dissemination and implementation of cancer research findings. We believe that by doing so we may improve the quality of cancer care and treatment outcomes. Accordingly, NCI is asking healthcare practitioners to identify factors that influence their access to and implementation of new and more effective research-based cancer care practices.

You can help guide NCI’s dissemination efforts by completing the enclosed survey. We hope that you will take this opportunity to inform NCI on how it can advance the delivery of cancer care innovations into clinical practice to benefit all cancer patients.

NCI is conducting this survey under contract with the University of Massachusetts, Donahue Institute. Your participation in this survey is completely voluntary. All your responses will be kept confidential and will not be disclosed to anyone outside of NCI or its contractor the Donahue Institute, except as required by law. Your identifying information will be kept in a separate database from your survey response and data will be reported in aggregate form only, so there will be no association between your responses and your personal information.

This survey should take approximately 10 minutes to complete, and you may skip questions that you prefer not to answer. Please mail your completed survey in the enclosed self-addressed stamped envelope no later than [TBD], 2005. If you have questions regarding this study, please contact Jeff Swarz at (413) 587-2401 or [email protected].

Thank you for helping to direct NCI’s ongoing efforts to assist healthcare practitioners in their efforts to provide cancer patients with the highest possible quality of care.

Sincerely,

Lenora Johnson Steven Ellis

Director Senior Manager

Office of Education and Special Initiatives Donahue Institute

National Cancer Institute University of Massachusetts

OMB #0925-0046-12

Exp. Date 10/31/2006

National Cancer Institute

Survey to Determine Factors

Affecting the Translation of Research

Into Cancer Care Practice

Thank you for participating. This survey is designed for health care professionals who spend at least a portion of their time in direct patient care.

Please fill bubbles in completely. You may use pencil or black or blue ball point pen. Do not use a felt tip pen.

1. Do you spend any of your professional time in direct patient care?

O Yes O No If no, your survey is complete. Please return it in the enclosed envelope.

This survey is intended only for health practitioners who spend some portion of their time in direct patient care.

2. In addition to your professional role as a practitioner, do you also act in any of the following capacities? (Please choose all that apply.)

O Administrator O Researcher or academic O Other

I. Introductory questions

The following questions focus on your perceptions and behaviors with regard to the implementation of current research findings into your practice of cancer care. Throughout this survey, the word "research" refers to reliable studies published by widely respected sources, such as peer reviewed journals. In this context, "research" does not include less formal observations of patient outcomes or response to treatment.

From your perspective as a practitioner, please indicate the extent to which you agree or disagree with the following statements.

Strongly Somewhat Somewhat Strongly Don't Know

Agree Agree Disagree Disagree or N/A

3. There is a gap between the cancer care that patients receive O O O O O

and the care indicated by current research.

4. When research findings contradict my professional experience, O O O O O

I tend to rely upon my experience as the basis for patient care.

II. Accessibility of current research findings

Don’t Know

Yes No or N/A

5. I have adequate access to the research I need to keep my practice current. O O O

6. I have adequate time available to access the research I need to support my O O O

practice.

7. How often do you rely on each of the following resources to obtain information regarding current research-indicated practices in cancer care?

Rarely

Frequently Occasionally or Never

A. Colleagues or experts from within your organization O O O

B. Colleagues or experts from outside your organization O O O

C. HMO provided guidelines O O O

D. Clinical practice guideline web sites O O O

E. Professional society web sites O O O

F. Federal agency web sites O O O

G. Systematic reviews & evidence summaries (e.g., Cochrane Collection, journal clubs) O O O

H. On-line courses/programs O O O

I. Peer-reviewed journals O O O

J. Non-peer reviewed journals or other publications O O O

K. Trainings or meetings within your organization O O O

L. Professional society meetings/conferences O O O

M. Programs or publications sponsored by pharmaceutical or medical device companies O O O

N. Other topic-specific events (such as Grand Rounds, presentations of research O O O

findings, special speakers, et cetera) Please Specify_______________________________________

8. From the above list of resources, please rank the top three resources in order of importance to you.

Enter letter code A-N.

 1. Most important resource  2. Second most important resource  3. Third most important resource

III. Organizational factors that may affect implementation of research-indicated practices

The following questions relate to organizational factors that may affect your implementation of new research- indicated practices.

9. Which of the following organizations best describes your primary practice setting?

Is it a... (choose one)

O University affiliated or teaching hospital O Independent office

O Cancer center O Health Maintenance Organization

O Community hospital O Veterans Administration hospital or clinic

O Community clinic O Some other type of organization (please specify)____________________________

References to "your organization" in the remainder of the survey refer to the primary practice setting you identify in question 9. All questions relate to the care and treatment of cancer.

10. Does your organization have a department or staff member explicitly responsible for the development, update, or implementation of guidelines for clinical practice?

O Yes O No O Unsure

11. Does your organization have a person responsible for identifying patients eligible for clinical trials?

O Yes O No O Unsure

Please indicate the extent to which you agree or disagree with the following statements.

Strongly Somewhat Somewhat Strongly Don't Know

Agree Agree Disagree Disagree or N/A

12. My organization effectively disseminates new research- O O O O O

indicated practices to staff.

13. My organization's leadership is committed to implementing O O O O O

new research-indicated practices.

14. My organization has information management systems that

effectively support implementation of new research-indicated O O O O O

practices.

15. My organization allows me to decide whether to change O O O O O

my practice in response to new research.

IV. Potential barriers to the implementation of research-indicated practices

The following questions consider factors that may impede the implementation of new research findings into practice.

Please indicate the extent to which you agree or disagree with the following statements.

Strongly Somewhat Somewhat Strongly Don't Know

Agree Agree Disagree Disagree or N/A

16. My organization's quality improvement efforts are driven by the O O O O O

need for cost reduction.

17. Insurance reimbursement rules often discourage me from O O O O O

implementing new practices.

18. Implementation of new practices is often hindered by a lack of O O O O O

available staff time.

19. Providing state-of-the-art care is often not possible for under- O O O O O

insured patients.

20. Within my organization, practitioners are encouraged to

perform a diagnostic evaluation of any patient with an O O O O O

abnormal cancer screening test regardless of ability to pay.

Strongly Somewhat Somewhat Strongly Don't Know

Agree Agree Disagree Disagree or N/A

21. Implementation of new practices is often hindered by a lack O O O O O

of specialized medical equipment/devices.

22. Research findings are often presented in a manner that makes O O O O O

them difficult to implement "at the bedside" or in the office.

23. The available literature on cancer care is often contradictory,

which discourages practitioners from making related O O O O O

changes regarding clinical practice.

24. The value of guidelines is limited by their lack of specificity O O O O O

when applied in a clinical setting.

25. Guidelines for cancer care are generally too broad and O O O O O

complex to be implemented effectively.

26. In general, what factor is most likely to determine whether you change your clinical practice based on something you learned through translational research?

V. Suggestions to improve the translation of research into practice

Following are some suggestions to improve the accessibility and implementation of new research-indicated practices.

Please rate each of these suggestions based on their potential to positively impact the translation* of research into practice. (*The process through which research is acquired and implemented in a clinical

setting.)

Excellent Good Fair Poor Don't

Suggestion Suggestion Suggestion Suggestion Know

27. Increase practitioner input to the process for establishing O O O O O

cancer research funding priorities.

28. Increase the availability of research focused on symptom O O O O O

management in cancer care.

29. Increase the availability of summary evidence reports, such as

systematic literature reviews, that clarify current consensus O O O O O

regarding best practices.

30. Provide web links to the original studies cited in clinical O O O O O

guidelines and evidence summaries.

Excellent Good Fair Poor Don't

Suggestion Suggestion Suggestion Suggestion Know

31. Provide tools to help organizations adapt clinical guide-

lines and evidence-based information for use at the point of O O O O O

patient care (e.g., practice flow charts, reminders placed in

patient charts, reminders sent via PDA).

32. Increase access to facilitators who are trained to assist prac- O O O O O

titioners as they try to implement changes in practice.

33. Increase the availability of train-the-trainer programs, through

which selected practitioners are trained as facilitators and O O O O O

then return to their organizations to train others on the latest

practices.

34. Develop a website that offers a free comprehensive collec-

tion of up-to-date cancer-related clinical guidelines and O O O O O

research studies.

35. Develop a website that allows practitioners to identify

relevant research topics and sends email notification of O O O O O

breaking research in those topical areas.

36. Increase the availability of successful practice implementa-

tion strategies or "how to" plans that might serve as models O O O O O

to other organizations/practitioners preparing to adopt a

change in practice.

37. Focus national dissemination efforts on a select

number of new treatments based on their potential to O O O O O

improve patient outcomes and quality of life.

38. Please rate your overall satisfaction with the efforts of the National Cancer Institute to support the dissemination of new research findings that impact cancer care.

O Very Satisfied O Somewhat Satisfied O Somewhat Dissatisfied O Very Dissatisfied O Don’t Know or N/A

39. To what extent do you agree that professional organizations along with the National Cancer Institute must increase their efforts to support the dissemination and implementation of new research- indicated practices?

O Strongly Agree O Somewhat Agree O Somewhat Disagree O Strongly Disagree O Don’t Know or N/A

40. Please identify one thing that you would like NCI or other national organizations to do in order to improve the translation of scientific research into practice.

__________________________________________________________________________________

___________________________________________________________________________________

VI. Practitioner and organizational profile

Finally, we have a few important questions that will help us to understand you and the organization for which you work.

41. In what year did you enter practice? (e.g., 1997) _______________

42. What is the five digit zip code for your business address? ______________

Don't

0 - 25% 26%-50% 51%-75% 76%-100% Know

43. Please estimate the proportion of the patients you serve O O O O O

who are economically disadvantaged.

44. Please estimate the proportion of the patients you serve O O O O O

who are ethnic or racial minorities.

45. Among your patients, what are the most common ethnic or racial minority groups. (List up to three.)

1) ____________________________________________

2) ____________________________________________

3) ____________________________________________

Please mail your completed survey in the enclosed self-addressed stamped envelope.

Thank you for your valuable time.

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