Supportive Care Service Availability for Cancer Caregivers in Community Oncology Practices

Study Overview
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Brief Summary
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The purpose of this study is to understand current practices for engaging with informal (unpaid) caregivers of patients with cancer, characterize the availability of supportive care services, and assess the perspectives of multi-disciplinary oncology health care providers regarding identifying and supporting caregivers.

Detailed Description
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The primary goals of this study are to: 1) estimate the prevalence of: a) caregiver identification practices, b) psychosocial and/or needs assessment practices for caregivers, and c) the availability of and funding models for supportive care services for caregivers at community oncology practices (Objective 1), and 2) assess the perspectives of multi-disciplinary oncology health care providers regarding: a) perceived responsibility for, and barriers to, assessing and supporting caregivers, b) the importance of and self-efficacy in communicating with caregivers, and c) preferences regarding systems approaches to assess and meet caregivers' needs (Objective 2). Additionally, we will explore various practice and provider -level factors that are associated with the listed outcomes in objectives 1 and 2 respectively (Objective 3a and 3b). This study is estimated to enroll 138 Supportive Care Leaders (e.g., Director of Psychosocial Oncology, Supportive Care Services, or Cancer Patient Support) and 690 multidisciplinary Oncology Providers including physicians, nurses, and physician assistants/nurse practitioners. Participants will complete a one-time web-based survey (estimated at 15-20 minutes to complete). The supportive care leader survey will capture: (1) practice characteristics including caregiver identification and psychosocial assessment practices and preferences; supportive care resources; practice structure; practice technology resources; and status of the Caregiver Advise Record and Enable (CARE) Act. The oncology provider survey will capture: (1) provider skills in caregiver communication; perceived responsibility, knowledge and skills, and awareness of resources for meeting caregiver needs; barriers to meeting caregiver needs; provider characteristics; and system intervention preferences. For data capture regarding supportive care leaders (Objective 1 and 3a), this will be a convenience sample of responders from all WF NCORP sites, therefore no randomization or stratification is necessary. Regarding objectives pertaining to oncology providers (Objective 2 and 3b), participating sites with corresponding supportive care leaders will identify an appropriate supportive care leader to generate 3 lists of providers: 1) physicians, 2) nurses, and 3) physician assistants/nurse practitioners who routinely provide cancer care (Oncology Care Provider Identification Form, Appendix B). Using previous Landscape data regarding oncology physicians, we estimate that 50% of practice groups have 1-9 oncology physicians, 25% have 10-20, and 25% have 20+ physicians. After practices respond with lists of physicians, nurses, and physician assistants/nurse practitioners, we will classify each site as small, medium, and large using the criteria for physicians listed above. Assuming similar distributions as seen in Landscape, we will randomly sample 4, 12, and 20 total providers at small, medium, and large sites respectively. With approximately 50% of practices participating, we plan to target a weighted average of 10 providers per practice with the goal of a weighted average of 5 completed provider surveys (50% response/practice) for a total of 690 providers included in objective 2 (sample size justification follows in section 9.3). In addition, we will stratify and proportionally allocate by provider types identified at each site using self-weighting samples supplied in their lists of providers. Therefore of those randomly sampled, we will target roughly the same proportion of physicians, nurses, and PA/nurse practitioners as identified from their site administrator. Coordinators at each NCORP practice will provide e-mail addresses only for randomly selected providers (selected numbers from a numbered list), based on the size of the center and stratified proportional to provider types.

Official Title
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Supportive Care Service Availability for Cancer Caregivers in Community Oncology Practices

Conditions
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Supportive Care

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: NCI Community Oncology Research Program (NCORP) components/subcomponents providing care to adult oncology patients. NCORP components/subcomponents willing to: a) identify a supportive care leader knowledgeable about supportive care services that may be available to the practice and b) assist with the identification and recruitment of oncology providers for a brief provider survey. NCORP components/subcomponents who share staff and supportive care services may participate as a single practice group A staff member at each site who is most knowledgeable about supportive care services for adult oncology patients (e.g., Director of Manger of Psychosocial Oncology, Supportive Care Services, or Cancer Patient Support). If an administrator or leader cannot be identified, the nurse manager or clinic director will be asked to identify a staff member most knowledgeable about psychosocial or supportive care services for adult oncology patients or complete the survey himself or herself. Must be a physician, nurse, or physician assistant/nurse practitioner, who routinely provides cancer care to adult oncology patients, including medical, radiation and surgical oncologists or physician assistants (PAs), nurse practitioners (NPs), and nurses who work in oncology settings. Must have been in practice at component/subcomponent for at least 6 months. Exclusion Criteria: Component/subcomponent exclusively care for pediatric oncology patients. Given the distinct caregiver experience and needs of caregivers of pediatric oncology patients, we are not including components/sub-components that exclusively provide care for pediatric oncology patients. Providers in practice less than 6 months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Supportive Care Leader<br>A staff member who is knowledgeable about supportive care services for adult oncology patients. | |
| Oncology Providers<br>Physicians, nurses, physicians assistants, nurse practitioners who routinely provide cancer care to adult oncology patients. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of Practices that have Mechanisms in Place to Identify Primary Caregivers | Practices that have a mechanism in place to identify and document a primary, informal caregiver for cancer patients will be identified by using the following Landscape 2017 Survey item: Does your practice have a mechanism in place to identify and document a primary, informal (unpaid) caregiver for cancer patients? | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Percent of Practices that have Mechanisms in Place to Provide Psychosocial and/or Needs Assessments for Caregivers | Methods, documentation, settings and timing will be collected and assessed from practices that have mechanisms in place to identify primary caregivers. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Percent of Practices that have Availability of and Funding Models for Supportive Care Services | Percent of practices that have availability of and funding models for supportive care services provided to patients only, caregivers only, or both patients and caregivers will be assessed using items and content adapted from the Service Availability Measure and the Supportive Care Resources surveys. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Providers' Perceived Responsibility per SPARCCS | Questions used to collect perceived responsibility are adapted from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) on a scale of 0-4, strongly disagree to strongly agree. These questions assess modifiable constructs that can be targeted for systems level interventions including: 1) questions assessing perceived responsibility for assessing caregivers; 2) questions assessing skills and time to support caregivers; and 3) questions assessing awareness of resources for caregivers in practice and community. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Providers' Perceived Responsibility for Barriers to Meeting Caregiver Needs | Barriers to meeting needs of caregivers will be assessed using a 20-item tool designed by our team in prior research which was adapted for this study. Providers will report the extent to which they believe each barrier (e.g., time, lack of specialized staff, reimbursement) impacts service delivery for caregivers on a scale of 0-3, not a barrier at all to Major barrier. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Providers' Ratings of Perceived Importance of Skills in Caregiver Communication | Providers' perceived skills in caregiver communication assesses providers' perceived importance, self-efficacy, and need for more training in 4 caregiver communication skills: 1) educating caregivers about ways to support a care recipient during treatment and recovery, 2) detecting when caregivers are anxious, depressed, or overwhelmed, 3) providing information about resources available to support caregivers, 4) assessing problems between caregivers and patients that impact patient treatment or recovery (15 items). These 15 items are adapted from a provider patient communication instrument on a scale of 0-4, not at all to extremely/very much. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 
| Providers' System Intervention Preferences | Providers' system intervention preferences will be assessed with 13 items assessing providers' preferences for offering different types of system interventions on a scale of 0-4, not alt all interested to extremely interested; 12 items assessing willingness and preferences for receiving training in each type of systems intervention on a scale of 0-2, definitely to no. | Included in One-Time Web-Based Survey; Up to 20 minutes Total | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Caregivers, Oncology, Cancer