Publications by authors named "David A Chambers"

82 Publications

Policy Implementation Science - An Unexplored Strategy to Address Social Determinants of Health.

Ethn Dis 2021 21;31(1):133-138. Epub 2021 Jan 21.

Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.

This commentary explores the ways in which robust research focused on policy implementation will increase our ability to understand how to - and how not to - address social determinants of health. We make three key points in this commentary. First, policies that affect our lives and health are developed and implemented every single day, like it or not. These include "small p" policies, such as those at our workplaces that influence whether we have affordable access to healthy food at work, as well as "large P" policies that, for example, determine at a larger level whether our children's schools are required to provide physical education. However, policies interact with context and are likely to have differential effects across different groups based on demographics, socioeconomic status, geography, and culture. We are unlikely to improve health equity if we do not begin to systematically evaluate the ways in which policies can incorporate evidence-based approaches to reducing inequities and to provide structural supports needed for such interventions to have maximal impact. A policy mandating physical education in schools will do little to address disparities in fitness and weight-related outcomes if all schools cannot provide the resources for physical education teachers and safe activity spaces. Second, as we argue for an increased emphasis on policy implementation science, we acknowledge its nascent status. Although the field of implementation science has become increasingly robust in the past decade, there has been only limited application to policy. However, if we are strategic and systematic in application of implementation science approaches and methods to health-related policy, there is great opportunity to discover its impact on social determinants. This will entail fundamental work to develop common measures of policy-relevant implementation processes and outcomes, to develop the capacity to track policy proposal outcomes, and to maximize our capacity to study natural experiments of policy implementation. Third, development of an explicit policy implementation science agenda focused on health equity is critical. This will include efforts to bridge scientific evidence and policy adoption and implementation, to evaluate policy impact on a range of health equity outcomes, and to examine differential effects of varied policy implementation processes across population groups. We cannot escape the reality that policy influences health and health equity. Policy implementation science can have an important bearing in understanding how policy impacts can be health-promoting and equitable.
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http://dx.doi.org/10.18865/ed.31.1.133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843047PMC
January 2021

Designing provider-focused implementation trials with purpose and intent: introducing the PRECIS-2-PS tool.

Implement Sci 2021 Jan 7;16(1). Epub 2021 Jan 7.

Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, Ontario, Canada.

Background: First articulated by Schwartz and Lellouch (1967), randomized controlled trials (RCTs) can be conceptualized along a continuum from more explanatory to more pragmatic. The purpose and intent of the former is to test interventions under ideal contexts, and the purpose and intent of the latter is to test interventions in real-world contexts. The PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) is a validated tool that helps researchers make decisions about the elements of the trial to match the overall purpose and intent of the trial along the continuum. The PRECIS-2 tool has guided the design of hundreds of RCTs. However, a few aspects of the tool would benefit from greater clarity, including its application to provider-focused implementation trials rather than patient-focused intervention trials.

Main Text: We describe the newly developed PRECIS-2-Provider Strategies (PRECIS-2-PS) tool, an extension of the PRECIS-2 tool, which has been adapted for trials testing provider-focused strategies. We elaborate on nine domains that can make a provider-focused trial more explanatory or more pragmatic, including eligibility, recruitment, setting, implementation resources, flexibility of provider strategies, flexibility of intervention, data collection, primary outcome, and primary analysis. We detail the complementary roles that researchers and stakeholders play in the trial design phase, with implications for generalizability of trial results to the contexts in which they are intended to be applied.

Conclusions: The PRECIS-2-PS tool is designed to help research and practice teams plan for provider-focused trials that reflect the overall intent and purpose of the trial. The tool has potential to help advance the science of provider-focused strategies across a range of trials, with the ultimate goal of facilitating the adoption, integration, and sustainability of provider-focused strategies outside the context of trials.
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http://dx.doi.org/10.1186/s13012-020-01075-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791810PMC
January 2021

Dissemination and Implementation Research at the National Cancer Institute: A Review of Funded Studies (2006-2019) and Opportunities to Advance the Field.

Cancer Epidemiol Biomarkers Prev 2021 Feb 2;30(2):260-267. Epub 2020 Dec 2.

National Cancer Institute, Rockville, Maryland.

Background: To ensure investment in cancer research reaches populations who can benefit, the NCI has funded implementation science grants since the Dissemination and Implementation Research in Health (DIRH) funding opportunities launched in 2006. We analyzed NCI-funded DIRH grants to provide a snapshot of implementation science conducted across the cancer care continuum and highlight areas ripe for exploration.

Methods: NCI-funded DIRH grants between fiscal years 2006 and 2019 were identified using the iSearch database. Two coders classified each grant by topic, populations studied, intervention and setting characteristics, strategies tested, study designs and methods used, and outcomes measured.

Results: Seventy-one grants were awarded addressing cancer prevention ( = 33), screening ( = 33), diagnosis ( = 4), treatment ( = 9), and/or survivorship ( = 11). Colorectal ( = 20), breast ( = 15), and cervical ( = 11) were the most studied cancers. Most grants focused on delivery of guidelines ( = 36) or behavioral change interventions ( = 18) in health care settings ( = 47), studying implementation processes ( = 37) and/or testing implementation strategies ( = 43) using experimental ( = 35) and quasi-experimental ( = 6) designs. Few studied sustainability ( = 7), scale-up ( = 2), deimplementation ( = 4), measure development ( = 6), or policy-level implementation ( = 6).

Conclusions: Current funding suggests researchers are studying implementation of cancer control interventions across the care continuum. However, research gaps remain in strategies for sustainability, scale-up, and deimplementation. More emphasis is needed on cancer treatment and survivorship. Additional focus on policy implementation and measure development is warranted.

Impact: Understanding the breadth of NCI-funded implementation science can inform future efforts to build the knowledge base on how to improve dissemination and implementation of evidence in cancer control.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0795DOI Listing
February 2021

What Can Implementation Science Do for You? Key Success Stories from the Field.

J Gen Intern Med 2020 11;35(Suppl 2):783-787

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.

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http://dx.doi.org/10.1007/s11606-020-06174-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652953PMC
November 2020

Advancing understanding and identifying strategies for sustaining evidence-based practices: a review of reviews.

Implement Sci 2020 10 9;15(1):88. Epub 2020 Oct 9.

Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden.

Background: Implementation science has focused mainly on the initial uptake and use of evidence-based practices (EBPs), with less attention to sustainment-i.e., continuous use of these practices, as intended, over time in ongoing operations, often involving adaptation to dynamic contexts. Declining EBP use following implementation is well-documented yet poorly understood. Using theories, models, and frameworks (TMFs) to conceptualize sustainment could advance understanding. We consolidated knowledge from published reviews of sustainment studies to identify TMFs with the potential to conceptualize sustainment, evaluate past uses of TMFs in sustainment studies, and assess the TMFs' potential contribution to developing sustainment strategies.

Methods: We drew upon reviews of sustainment studies published within the past 10 years, evaluated the frequency with which included articles used a TMF for conceptualizing sustainment, and evaluated the relevance of TMFs to sustainment research using the Theory, Model, and Framework Comparison and Selection Tool (T-CaST). Specifically, we examined whether the TMFs were familiar to researchers, hypothesized relationships among constructs, provided a face-valid explanation of relationships, and included sustainment as an outcome.

Findings: Nine sustainment reviews referenced 648 studies; these studies cited 76 unique TMFs. Only 28 TMFs were used in more than one study. Of the 19 TMFs that met the criteria for T-CaST analysis, six TMFs explicitly included sustainment as the outcome of interest, 12 offered face-valid explanations of proposed conceptual relationships, and six identified mechanisms underlying relationships between included constructs and sustainment. Only 11 TMFs performed adequately with respect to all these criteria.

Conclusions: We identified 76 TMFs that have been used in sustainment studies. Of these, most were only used once, contributing to a fractured understanding of sustainment. Improved reporting and use of TMFs may improve understanding of this critical topic. Of the more consistently used TMFs, few proposed face-valid relationships between included constructs and sustainment, limiting their ability to advance our understanding and identify potential sustainment strategies. Future research is needed to explore the TMFs that we identified as potentially relevant, as well as TMFs not identified in our study that nonetheless have the potential to advance our understanding of sustainment and identification of strategies for sustaining EBP use.
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http://dx.doi.org/10.1186/s13012-020-01040-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545853PMC
October 2020

Building the Next Generation of Researchers: Mentored Training in Dissemination and Implementation Science.

Acad Med 2021 01;96(1):86-92

A. Sales is professor, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

Problem: Dissemination and implementation (D&I) science provides the tools needed to close the gap between known intervention strategies and their effective application. The authors report on the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) program-a D&I training program for postdoctoral or early-career cancer prevention and control scholars.

Approach: MT-DIRC was a 2-year training institute in which fellows attended 2 annual Summer Institutes and other conferences and received didactic, group, and individual instruction; individualized mentoring; and other supports (e.g., pilot funding). A quasi-experimental design compared changes in 3 areas: mentoring, skills, and network composition. To evaluate mentoring and D&I skills, data from fellows on their mentors' mentoring competencies, their perspectives on the importance of and satisfaction with mentoring priority areas, and their self-rated skills in D&I competency domains were collected. Network composition data were collected from faculty and fellows for 3 core social network domains: contact, mentoring, and collaboration. Paired t tests (mentoring), linear mixed models (skills), and descriptive analyses (network composition) were performed.

Outcomes: Mentors were rated as highly competent across all mentoring competencies, and each mentoring priority area showed reductions in gaps between satisfaction and importance between the 6 and 18 months post-first Summer Institute. Fellows' self-rated skills in D&I competencies improved significantly in all domains over time (range: 42.5%-52.9% increase from baseline to 18 months post-first Summer Institute). Mentorship and collaboration networks grew over time, with the highest number of collaboration network ties for scholarly manuscripts (n = 199) in 2018 and for research projects (n = 160) in 2019.

Next Steps: Building on study findings and existing literature, mentored training of scholars is an important approach for building D&I skills and networks, and thus to better applying the vast amount of available intervention evidence to benefit cancer control.
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http://dx.doi.org/10.1097/ACM.0000000000003750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769184PMC
January 2021

The "secret sauce" for a mentored training program: qualitative perspectives of trainees in implementation research for cancer control.

BMC Med Educ 2020 Jul 28;20(1):237. Epub 2020 Jul 28.

Prevention Research Center, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA.

Background: Mentored training approaches help build capacity for research through mentoring networks and skill building activities. Capacity for dissemination and implementation (D&I) research in cancer is needed and mentored training programs have been developed. Evaluation of mentored training programs through quantitative approaches often provides us with information on "what" improved for participants. Qualitative approaches provide a deeper understanding of "how" programs work best.

Methods: Qualitative interviews were conducted with 21 fellows of the National Cancer Institute-funded Mentored Training for Dissemination and Implementation in Cancer to gain understanding of their experiences with mentoring received during the program. Fellows were selected from all 55 trained participants based upon their gain in D&I research skills (highest and lowest) and number of collaborative connections in the program network (highest and lowest) reported in previous quantitative surveys. Phone interviews were recorded with permission, transcribed verbatim, and de-identified for analysis. Codes were developed a priori to reflect interview guide concepts followed by further development and iterative coding of three common themes that emerged: 1) program and mentoring structure, 2) importance of mentor attributes, and 3) enhanced capacity: credentials, confidence, credibility and connections.

Results: Interviews provided valuable information about program components that worked best and impacts attributed to participation in the program. Fellows reported that regular monthly check-in calls with mentors helped to keep their research moving forward and that group mentoring structures aided in their learning of basic D&I research concepts and their application. Accessible, responsive, and knowledgeable mentors were commonly mentioned by fellows as a key to their success in the program. Fellows mentioned various forms of impact that they attributed to their participation in the program including gaining credibility in the field, a network of peers and experts, and career developments (e.g., collaborative publications and grant funding).

Conclusions: These findings suggest that mentored training works best when mentoring is structured and coupled with applied learning and when respected and dedicated mentors are on board. Increased scientific collaborations and credibility within a recognized network are important trainee experiences that should be considered when designing, implementing, and sustaining mentored training programs.
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http://dx.doi.org/10.1186/s12909-020-02153-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385963PMC
July 2020

Practitioner Engagement in Implementation Science: Initiatives and Opportunities.

J Public Health Manag Pract 2021 Mar-Apr 01;27(2):102-104

Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland.

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http://dx.doi.org/10.1097/PHH.0000000000001222DOI Listing
June 2020

An Extension of RE-AIM to Enhance Sustainability: Addressing Dynamic Context and Promoting Health Equity Over Time.

Front Public Health 2020 12;8:134. Epub 2020 May 12.

School of Medicine, University of Colorado Denver, Aurora, CO, United States.

RE-AIM is a widely adopted, robust implementation science (IS) framework used to inform intervention and implementation design, planning, and evaluation, as well as to address short-term maintenance. In recent years, there has been growing focus on the longer-term sustainability of evidence-based programs, policies and practices (EBIs). In particular, investigators have conceptualized sustainability as the continued health impact and delivery of EBIs over a longer period of time (e.g., years after initial implementation) and incorporated the complex and evolving nature of context. We propose a reconsideration of RE-AIM to integrate recent conceptualizations of sustainability with a focus on addressing dynamic context and promoting health equity. In this Perspective, we present an extension of the RE-AIM framework to guide planning, measurement/evaluation, and adaptations focused on enhancing sustainability. We recommend consideration of: (1) extension of "maintenance" within RE-AIM to include recent conceptualizations of dynamic, longer-term intervention sustainability and "evolvability" across the life cycle of EBIs, including adaptation and potential de-implementation in light of changing and evolving evidence, contexts, and population needs; (2) iterative application of RE-AIM assessments to guide adaptations and enhance long-term sustainability; (3) explicit consideration of equity and cost as fundamental, driving forces that need to be addressed across RE-AIM dimensions to enhance sustainability; and (4) use or integration of RE-AIM with other existing frameworks that address key contextual factors and examine multi-level determinants of sustainability. Finally, we provide testable hypotheses and detailed research questions to inform future research in these areas.
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http://dx.doi.org/10.3389/fpubh.2020.00134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235159PMC
May 2020

Mentored training and its association with dissemination and implementation research output: a quasi-experimental evaluation.

Implement Sci 2020 05 11;15(1):30. Epub 2020 May 11.

Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA.

Background: There is a continued need to evaluate training programs in dissemination and implementation (D&I) research. Scientific products yielded from trainees are an important and objective measure to understand the capacity growth within the D&I field. This study evaluates our mentored training program in terms of scientific productivity among applicants.

Methods: Post-doctoral and early-career cancer researchers were recruited and applied to the R25 Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) between 2014 and 2017. Using application details and publicly available bibliometric and funding data, we compared selected fellows with unsuccessful applicants (nonfellows). We extracted Scopus citations and US federal grant funding records for all applicants (N = 102). Funding and publication abstracts were de-identified and coded for D&I focus and aggregated to the applicant level for analysis. Logistic regression models were explored separately for the odds of (1) a D&I publication and (2) US federal grant funding post year of application among fellows (N = 55) and nonfellows (N = 47). Additional models were constructed to include independent variables that attenuated the program's association by 5% or more. Only US-based applicants (N = 87) were included in the grant funding analysis.

Results: Fellows and nonfellows were similar across several demographic characteristics. Fellows were more than 3 times more likely than nonfellows to have grant funding after MT-DIRC application year (OR 3.2; 95% CI 1.1-11.0) while controlling for time since application year; the association estimate was 3.1 (95% CI 0.98-11.0) after adjusting for both cancer research area and previous grant funding. For publications, fellows were almost 4 times more likely to publish D&I-focused work adjusting for time (OR 3.8; 95% CI 1.7-9.0). This association lessened after adjusting for previous D&I publication and years since undergraduate degree (OR 2.9; 95% CI 1.2-7.5).

Conclusions: We document the association of a mentored training approach with built-in networks of peers to yield productive D&I researchers. Future evaluation efforts could be expanded to include other forms of longer-term productivity such as policy or practice change as additional objective measures. D&I research trainings in the USA and internationally should consider common evaluation measures.
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http://dx.doi.org/10.1186/s13012-020-00994-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216589PMC
May 2020

A systematic review of empirical studies examining mechanisms of implementation in health.

Implement Sci 2020 04 16;15(1):21. Epub 2020 Apr 16.

Division of Cancer Control and Population Science, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.

Background: Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms.

Methods: We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms "mechanism," "mediator," or "moderator." Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality.

Results: Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms.

Conclusions: Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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http://dx.doi.org/10.1186/s13012-020-00983-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164241PMC
April 2020

Future directions for implementation science at the National Cancer Institute: Implementation Science Centers in Cancer Control.

Transl Behav Med 2021 Mar;11(2):669-675

Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.

The National Cancer Institute (NCI) Cancer Moonshot initiative seeks to accelerate cancer research for the USA. One of the scientific priorities identified by the Moonshot's Blue Ribbon Panel (BRP) of scientific experts was the implementation of evidence-based approaches. In September 2019, the NCI launched the Implementation Science Centers in Cancer Control (ISC3 or "Centers") initiative to advance this Moonshot priority. The vision of the ISC3 is to promote the development of research centers to build capacity and research in high-priority areas of cancer control implementation science (e.g., scale-up and spread, sustainability and adaptation, and precision implementation), build implementation laboratories within community and clinical settings, improve the state of measurement and methods, and improve the adoption, implementation, and sustainment of evidence-based cancer control interventions. This paper highlights the research agenda, vision, and strategic direction for these Centers and encourages transdisciplinary scientists to learn more about opportunities to collaborate with these Centers.
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http://dx.doi.org/10.1093/tbm/ibaa018DOI Listing
March 2021

Unpacking the complexities of de-implementing inappropriate health interventions.

Implement Sci 2020 01 9;15(1). Epub 2020 Jan 9.

Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, #3E424, Bethesda, MD, 20850, USA.

De-implementing inappropriate health interventions is essential for minimizing patient harm, maximizing efficient use of resources, and improving population health. Research on de-implementation has expanded in recent years as it cuts across types of interventions, patient populations, health conditions, and delivery settings. This commentary explores unique aspects of de-implementing inappropriate interventions that differentiate it from implementing evidence-based interventions, including multi-level factors, types of action, strategies for de-implementation, outcomes, and unintended negative consequences. We highlight opportunities to continue to advance research on the de-implementation of inappropriate interventions in health care and public health.
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http://dx.doi.org/10.1186/s13012-019-0960-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950868PMC
January 2020

Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.

Trials 2019 Dec 27;20(1):779. Epub 2019 Dec 27.

, Edinburgh, Scotland.

Background: Building capacity in research funding organizations to support the conduct of pragmatic clinical trials is an essential component of advancing biomedical and public health research. To date, efforts to increase the ability to design and carry out pragmatic trials have largely focused on training researchers. To complement these efforts, we developed an interactive workshop tailored to meet the roles and responsibilities of program scientists at the National Cancer Institute-the leading cancer research funding agency in the USA. The objectives of the workshop were to improve the understanding of pragmatic trials and enhance the capacity to distinguish between elements that make a trial more pragmatic or more explanatory among key programmatic staff. To our knowledge, this is the first reported description of such a workshop.

Main Body: The workshop was developed to meet the needs of program scientists as researchers and stewards of research funds, which often includes promoting scientific initiatives, advising prospective applicants, collaborating with grantees, and creating training programs. The workshop consisted of presentations from researchers with expertise in the design and interpretation of trials across the explanatory-pragmatic continuum. Presentations were followed by interactive, small-group exercises to solidify participants' understanding of the purpose and conduct of these trials, which were tailored to attendees' areas of expertise across the cancer control continuum and designed to reflect their scope of work as program scientists at NCI. A total of 29 program scientists from the Division of Cancer Control and Population Sciences and the Division of Cancer Prevention participated; 19 completed a post-workshop evaluation. Attendees were very enthusiastic about the workshop: they reported improved knowledge, significant relevance of the material to their work, and increased interest in pragmatic trials across the cancer control continuum.

Conclusion: Training program scientists at major biomedical research agencies who are responsible for developing funding opportunities and advising grantees is essential for increasing the quality and quantity of pragmatic trials. Together with workshops for other target audiences (e.g., academic researchers), this approach has the potential to shape the future of pragmatic trials and continue to generate more and better actionable evidence to guide decisions that are of critical importance to health care practitioners, policymakers, and patients.
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http://dx.doi.org/10.1186/s13063-019-3934-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935210PMC
December 2019

Blending Insights from Implementation Science and the Social Sciences to Mitigate Inequities in Screening for Hereditary Cancer Syndromes.

Int J Environ Res Public Health 2019 10 15;16(20). Epub 2019 Oct 15.

Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.

Genomic screening to identify people at high risk for adult-onset hereditary conditions has potential to improve population health. However, if not equitably accessible, genomics-informed screening programs will exacerbate existing health inequities or give rise to new ones. To realize the disease prevention potential of these screening tools, we need strategies to broaden their reach. We propose a conceptual framework that merges insights from implementation science and sociological research on health inequities. Our framework does three things: first, it broadens the arenas of action beyond those typically addressed in implementation science frameworks; second, it argues for recruiting more diverse partners to share the work of implementation and dissemination; and third, it shows how implementation activities can be coordinated more effectively among those partners. We use screening for hereditary breast and ovarian cancers (HBOC) as a case to illustrate how this enhanced framework could guide implementation science and distribute the benefits of genomic medicine more equitably. Although our example is specific to genomics, this approach is more broadly applicable to the field of implementation science. Coordinated action among multiple stakeholders could translate a host of new technologies from the bench to the trench without creating new inequities or exacerbating existing ones.
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http://dx.doi.org/10.3390/ijerph16203899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843353PMC
October 2019

Designing for Accelerated Translation (DART) of Emerging Innovations in Health.

J Clin Transl Sci 2019 Jun 30;3(2-3):53-58. Epub 2019 Jul 30.

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

Accelerating innovation translation is a priority for improving healthcare and health. Although dissemination and implementation (D&I) research has made significant advances over the past decade, it has attended primarily to the implementation of long-standing, well-established practices and policies. We present a conceptual architecture for speeding translation of promising innovations as candidates for iterative testing in practice. Our framework to aims to clarify whether, when, and how to act on evolving evidence to improve healthcare. We view translation of evidence to practice as a dynamic process and argue that much evidence can be acted upon even when uncertainty is moderately high, recognizing that this evidence is evolving and subject to frequent reevaluation. The DART framework proposes that additional factors-demand, risk, and cost, in addition to the evolving evidence base-should influence the pace of translation over time. Attention to these underemphasized factors may lead to more dynamic decision-making about whether or not to adopt an emerging innovation or de-implement a suboptimal intervention. Finally, the DART framework outlines key actions that will speed movement from evidence to practice, including forming meaningful stakeholder partnerships, designing innovations for D&I, and engaging in a learning health system.
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http://dx.doi.org/10.1017/cts.2019.386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746422PMC
June 2019

Capacity-building and training opportunities for implementation science in mental health.

Psychiatry Res 2020 01 9;283:112511. Epub 2019 Aug 9.

Division of Services and Interventions Research, National Institute of Mental Health, United States. Electronic address:

This article traces efforts over the past decade by the National Institute of Mental Health, of the US National Institutes of Health, and other US organizations to build capacity for mental health researchers to advance activities in implementation science. Authors briefly chronicle the antecedents to the field's growth, and describe funding opportunities, workshop and conferences, training programs, and other initiatives that have collectively engaged hundreds of mental health researchers in the development and execution of implementation studies across the breadth of contexts where mental health care and prevention programs are delivered to those in need. The authors summarize a number of key initiatives and present potential next steps to further build the capacity for a new generation of implementation studies in mental health.
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http://dx.doi.org/10.1016/j.psychres.2019.112511DOI Listing
January 2020

Economic analysis in behavioral health: Toward application of standardized methodologies.

Health Psychol 2019 Aug;38(8):672-679

Department of Psychology.

Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000769DOI Listing
August 2019

Beyond Public Health Genomics: Can Big Data and Predictive Analytics Deliver Precision Public Health?

Public Health Genomics 2018 17;21(5-6):244-250. Epub 2019 Jul 17.

Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.

The field of public health genomics has matured in the past two decades and is beginning to deliver genomic-based interventions for health and health care. In the past few years, the terms precision medicine and precision public health have been used to include information from multiple fields measuring biomarkers as well as environmental and other variables to provide tailored interventions. In the context of public health, "precision" implies delivering the right intervention to the right population at the right time, with the goal of improving health for all. In addition to genomics, precision public health can be driven by "big data" as identified by volume, variety, and variability in biomedical, sociodemographic, environmental, geographic, and other information. Most current big data applications in health are in elucidating pathobiology and tailored drug discovery. We explore how big data and predictive analytics can contribute to precision public health by improving public health surveillance and assessment, and efforts to promote uptake of evidence-based interventions, by including more extensive information related to place, person, and time. We use selected examples drawn from child health, cardiovascular disease, and cancer to illustrate the promises of precision public health, as well as current methodologic and analytic challenges to big data to fulfill these promises.
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http://dx.doi.org/10.1159/000501465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687519PMC
July 2019

Sharpening our focus on designing for dissemination: Lessons from the SPRINT program and potential next steps for the field.

Authors:
David A Chambers

Transl Behav Med 2020 12;10(6):1416-1418

Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.

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http://dx.doi.org/10.1093/tbm/ibz102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973456PMC
December 2020

Evaluation of the Cancer Control P.L.A.N.E.T. Web Portal.

J Public Health Manag Pract 2021 Jan/Feb;27(1):E1-E8

Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (Drs Percy-Laurry, Heurtin-Roberts, Norton, and Chambers and Ms Uy); and The CDM Group Inc, Bethesda, Maryland (Dr McDonnell).

Context: The Cancer Control P.L.A.N.E.T. (P.L.A.N.E.T.) Web portal was designed to ease access to data and evidence-based resources for cancer control practitioners and researchers focused on developing, implementing, and evaluating cancer control programs.

Objectives: To determine usability, applicability, and opportunities to improve the P.L.A.N.E.T. Web portal after significant changes to the portal over time.

Design: The National Cancer Institute surveyed and interviewed cancer control professionals to assess factors influencing utilization of P.L.A.N.E.T. Data were collected from May 2017 to June 2018 via partner agencies, electronic publications, and online links.

Outcome Measures: Descriptive statistics with χ test were used to analyze the quantitative data and examine the relationship among variables. Qualitative interviews further informed the quantitative analysis.

Results: Of the 724 participants surveyed, 51% were users of P.L.A.N.E.T., with the majority accessing P.L.A.N.E.T. within the last 6 months. Most users felt that P.L.A.N.E.T. effectively met their needs for accessing specific cancer data, identifying evidenced-based programs, and ascertaining details on various cancer topics. There were statistically significant differences in demographic characteristics between users and nonusers of P.L.A.N.E.T., where users were more likely to have more experience in the cancer field, were older in age, and located in southern states.

Conclusion: Results indicate that P.L.A.N.E.T. is seen as a viable and credible source for cancer control program planning and delivery. A reassessment of P.L.A.N.E.T.'s goals is warranted, which may support reaching out to new audiences, amplifying or removing underutilized resources, and adding additional resources and topics. Consideration for training and tutorials on P.L.A.N.E.T. would benefit partner agencies and build capacity for evidence-based program development.
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http://dx.doi.org/10.1097/PHH.0000000000001043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954980PMC
January 2022

The Impact of Big Data Research on Practice, Policy, and Cancer Care.

Am Soc Clin Oncol Educ Book 2019 Jan 17;39:e167-e175. Epub 2019 May 17.

6 Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH.

The concept of "big data" research-the aggregation and analysis of biologic, clinical, administrative, and other data sources to drive new advances in biomedical knowledge-has been embraced by the cancer research enterprise. Although much of the conversation has concentrated on the amalgamation of basic biologic data (e.g., genomics, metabolomics, tumor tissue), new opportunities to extend potential contributions of big data to clinical practice and policy abound. This article examines these opportunities through discussion of three major data sources: aggregated clinical trial data, administrative data (including insurance claims data), and data from electronic health records. We will discuss the benefits of data use to answer key oncology practice and policy research questions, along with limitations inherent in these complex data sources. Finally, the article will discuss overarching themes across data types and offer next steps for the research, practice, and policy communities. The use of multiple sources of big data has the promise of improving knowledge and providing more accurate data for clinicians and policy decision makers. In the future, optimization of machine learning may allow for current limitations of big data analyses to be attenuated, thereby resulting in improved patient care and outcomes.
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http://dx.doi.org/10.1200/EDBK_238057DOI Listing
January 2019

How do researchers conceptualize and plan for the sustainability of their NIH R01 implementation projects?

Implement Sci 2019 05 9;14(1):50. Epub 2019 May 9.

Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Background: Inadequate sustainability of implementation of evidence-based interventions has led to calls for research on how sustainability can be optimized. To advance our understanding of intervention sustainability, we explored how implementation researchers conceptualized and planned for the sustainability of their implemented interventions with studies funded by the United States (US) National Institutes of Health (NIH).

Methods: We used sequential, mixed methods to explore how researchers conceptualized and planned for the sustainability of the health interventions using (1) a document review of all active and completed US NIH R01 Grants and Equivalents reviewed within the Dissemination and Implementation Research in Health (DIRH) Study Section between 2004 and 2016 and (2) a qualitative content analysis of semi-structured interviews with NIH R01 DIRH grant recipients.

Results: We found 277 R01 profiles within the DIRH study section listed on the US NIH RePORTER website including 84 that were eligible for screening. Of the 84 unique projects, 76 (90.5%) had primary implementation outcomes. Of the 76 implementation project profiles, 51 (67.1%) made references to sustainability and none referred to sustainability planning. In both profiles and interviews, researchers conceptualized sustainability primarily as the continued delivery of interventions, programs, or implementation strategies. Few researchers referenced frameworks with sustainability constructs and offered limited information on how they operationalized frameworks. Researchers described broad categories of approaches and strategies to promote sustainability and key factors that may influence researchers to plan for sustainability, such as personal beliefs, self-efficacy, perception of their role, and the challenges of the grant funding system.

Conclusions: We explored how US NIH R01 DIRH grant recipients conceptualized and planned for the sustainability of their interventions. Our results identified the need to test, consolidate, and provide guidance on how to operationalize sustainability frameworks, and to develop strategies on how funders and researchers can advance sustainability research.
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http://dx.doi.org/10.1186/s13012-019-0895-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506963PMC
May 2019

The current state of funded NIH grants in implementation science in genomic medicine: a portfolio analysis.

Genet Med 2019 05 26;21(5):1218-1223. Epub 2017 Oct 26.

Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA.

Purpose: Implementation science offers methods to evaluate the translation of genomic medicine research into practice. The extent to which the National Institutes of Health (NIH) human genomics grant portfolio includes implementation science is unknown. This brief report's objective is to describe recently funded implementation science studies in genomic medicine in the NIH grant portfolio, and identify remaining gaps.

Methods: We identified investigator-initiated NIH research grants on implementation science in genomic medicine (funding initiated 2012-2016). A codebook was adapted from the literature, three authors coded grants, and descriptive statistics were calculated for each code.

Results: Forty-two grants fit the inclusion criteria (~1.75% of investigator-initiated genomics grants). The majority of included grants proposed qualitative and/or quantitative methods with cross-sectional study designs, and described clinical settings and primarily white, non-Hispanic study populations. Most grants were in oncology and examined genetic testing for risk assessment. Finally, grants lacked the use of implementation science frameworks, and most examined uptake of genomic medicine and/or assessed patient-centeredness.

Conclusion: We identified large gaps in implementation science studies in genomic medicine in the funded NIH portfolio over the past 5 years. To move the genomics field forward, investigator-initiated research grants should employ rigorous implementation science methods within diverse settings and populations.
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http://dx.doi.org/10.1038/gim.2017.180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920776PMC
May 2019

Pragmatic clinical trials offer unique opportunities for disseminating, implementing, and sustaining evidence-based practices into clinical care: Proceedings of a workshop.

Healthc (Amst) 2019 Mar 26;7(1):51-57. Epub 2018 Dec 26.

The National Institutes of Health (NIH) Health Care Systems (HCS) Research Collaboratory hosted a workshop to explore challenges and strategies for the dissemination, implementation, and sustainability of findings from pragmatic clinical trials (PCTs) embedded in HCS. PCTs are designed to assess the impact of interventions delivered in usual or real-world conditions and leverage existing infrastructure to answer important clinical questions. The goal of the workshop was to discuss strategies for conducting impactful future PCTs that bridge the gap between evidence, practice, and policy. This paper summarizes presentations about how to design and conduct PCTs embedded in HCS and use dissemination and implementation strategies during the planning and conduct of projects, emphasizing the ever-changing world of care delivery and the need for pragmatic trial operations to adapt at various levels of operation.
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http://dx.doi.org/10.1016/j.hjdsi.2018.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557660PMC
March 2019

Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control.

Cancer Causes Control 2018 Dec 7;29(12):1221-1230. Epub 2018 Dec 7.

Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA.

Purpose: In 2015-2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants' knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration.

Methods: Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants.

Results: Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates.

Conclusions: Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.
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http://dx.doi.org/10.1007/s10552-018-1108-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384813PMC
December 2018

Conceptualizing De-Implementation in Cancer Care Delivery.

J Clin Oncol 2019 01 8;37(2):93-96. Epub 2018 Nov 8.

1 National Cancer Institute, Rockville, MD.

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http://dx.doi.org/10.1200/JCO.18.00589DOI Listing
January 2019

Sustaining knowledge translation interventions for chronic disease management in older adults: protocol for a systematic review and network meta-analysis.

Syst Rev 2018 09 15;7(1):140. Epub 2018 Sep 15.

Li Ka Shing Knowledge Institute, St. Michael's Hospital, Knowledge Translation Program, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.

Background: Failure to sustain knowledge translation (KT) interventions impacts patients and health systems, diminishing confidence in future implementation. Sustaining KT interventions used to implement chronic disease management (CDM) interventions is of critical importance given the proportion of older adults with chronic diseases and their need for ongoing care. Our objectives are to (1) complete a systematic review and network meta-analysis of the effectiveness and cost-effectiveness of sustainability of KT interventions that target CDM for end-users including older patients, clinicians, public health officials, health services managers and policy-makers on health care outcomes beyond 1 year after implementation or the termination of initial project funding and (2) use the results of this review to complete an economic analysis of the interventions identified to be effective.

Methods: For objective 1, comprehensive searches of relevant electronic databases (e.g. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of health care provider organisations and funding agencies will be conducted. We will include randomised controlled trials (RCTs) examining the impact of a KT intervention targeting CDM in adults aged 65 years and older. To examine cost, economic studies (e.g. cost, cost-effectiveness analyses) will be included. Our primary outcome will be the sustainability of the delivery of the KT intervention beyond 1 year after implementation or termination of study funding. Secondary outcomes will include behaviour changes at the level of the patient (e.g. symptom management) and clinician (e.g. physician test ordering) and health system (e.g. cost, hospital admissions). Article screening, data abstraction and risk of bias assessment will be completed independently by two reviewers. Using established methods, if the assumption of transitivity is valid and the evidence forms a connected network, Bayesian random-effects pairwise and network meta-analysis will be conducted. For objective 2, we will build a decision analytic model comparing effective interventions to estimate an incremental cost-effectiveness ratio.

Discussion: Our results will inform knowledge users (e.g. patients, clinicians, policy-makers) regarding the sustainability of KT interventions for CDM. Dissemination plan of our results will be tailored to end-users and include passive (e.g. publications, website posting) and interactive (e.g. knowledge exchange events with stakeholders) strategies.

Systematic Review Registration: PROSPERO CRD42018084810.
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http://dx.doi.org/10.1186/s13643-018-0808-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138921PMC
September 2018

A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health.

PLoS Med 2018 08 2;15(8):e1002631. Epub 2018 Aug 2.

Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, United States of America.

In a Policy Forum, Muin Khoury and colleagues discuss research on the clinical application of genome sequencing data.
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http://dx.doi.org/10.1371/journal.pmed.1002631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071954PMC
August 2018