Abstract
Although many trials of cancer screening interventions evaluate efficacy and effectiveness, less research focuses on how to sustain interventions in non-research settings, which limit the potential reach of these interventions. Identifying the factors that influence the potential for sustainability is critical. We evaluate the factors influencing sustainability of PreView, a Cancer Screening Intervention, within the context of the Practical, Robust Implementation and Sustainability Model (PRISM). PRISM includes organizational and patient perspectives of the intervention as well as characteristics of the organizational and patient recipients. It considers how the program or intervention design, external environment, implementation, and sustainability infrastructure and the recipients influence program adoption, implementation, and maintenance. We evaluate the attempts at sustainability of PreView within the constructs of PRISM. Encouraging patients to use PreView was more difficult outside of a clinical trial. Organizational perspectives on how the intervention fit in with other goals, patient perspectives on how the intervention is individualized (i.e. being able to choose which cancer screening to address) and focused on barriers, patient characteristics (i.e. having multiple comorbidities making cancer screening less of a priority), organizational characteristics (i.e. middle managers having competing responsibilities), external environment influences (i.e. reimbursement for achieving certain cancer screening goals), and sustainability infrastructure all affect the likelihood of PreView being sustained in clinical practice. Despite advance planning for sustainability, adapting interventions to achieve sustainability is difficult. Lessons learned from evaluating PreView within the PRISM model can inform future sustainability efforts.
Highlights
The United States Preventive Services Task Force (USPSTF) recom mends mammography screening for women aged 50–74, cervical cancer screening for women aged 50–64, and colorectal cancer (CRC) screening for those aged 50–75 (Siu, 2016; Curry et al, 2018; Grossman et al, 2018)
Given the importance of sustaining an intervention in clinical prac tice, we planned for a twelve month maintenance phase that would be conducted after completion of the PreView trial, in which we addressed the following questions: (1) How can we maintain a cancer screening intervention once the randomized controlled trial (RCT) is complete? (2) Which factors influenced the potential for sustainability of PreView? (3) What are lessons learned when trying to maintain and disseminate the results of a clinical trial?
There was uniform agreement on the strength of evidence – with the exception of prostate cancer screening, which remained controversial throughout the study – there was concern about program-related burdens placed on frontline staff
Summary
The United States Preventive Services Task Force (USPSTF) recom mends mammography screening for women aged 50–74, cervical cancer screening for women aged 50–64, and colorectal cancer (CRC) screening for those aged 50–75 (Siu, 2016; Curry et al, 2018; Grossman et al, 2018). The USPSTF previously recommended against PSA screening, current guidelines recommend a shared decisionmaking approach to PSA screening for men aged 55–69 (Moyer, 2012). Few interventions address all recommended cancer screenings for which an individual is due. With the input of patients and providers, we developed PreView, an Interactive Video Doctor intervention, that simulates interaction with a real clinician and addresses all cancer screening and discussions for which an individual aged 50–70 may be due (Arora et al, 2013). The clinician receives a paper-based “Provider Alert,” including an assessment of patients’ screening status, readiness to screen, individual barriers, as well as possible responses that could help the patient overcome identified barriers to screening
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