Ovarian Cancers Evolving Paradigms in Research and Care (2016) / Chapter Skim
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7 Dissemination and Implementation
7 Dissemination and Implementation
Pages 279-298
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In this chapter, an overview of the science of dissemination and implementation (D&I) is presented and then applied to the research on ovarian cancers.
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DISSEMINATION Dissemination is an active approach of spreading evidence-based interventions to the target audience via determined channels using planned strat DisseminaƟon and ImplementaƟon Studies Sustainment ImplementaƟon AdopƟon/ PreparaƟon ExploraƟon EffecƟveness Studies Efficacy Studies PreintervenƟon FIGURE 7-1 Stages of research and phases of dissemination and implementation. SOURCES: Brownson et al., 2012; NRC and IOM, 2009.
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. Passive methods of dissemination such as scientific journals, practice guidelines, and mass mailings are not as effective as such methods as personal technical assistance, point-of-decision prompts, and mass media campaigns (Rabin et al., 2006)
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. The Commonwealth Fund has developed eight strategies for systemic approaches to disseminating evidenced-based practices in national campaigns for quality improvement (The Commonwealth Fund, 2010)
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. Passive diffusion using audiovisual materials and electronic publications, along with didactic educational meetings, is generally ineffective (Bero et al., 1998)
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, having health care providers deliver smoking cessation message to patients during an office visit resulted in positive outcomes (AHRQ, 2012)
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Implementation is particularly complex in the clinical setting for cancer treatment, in part because there are multiple types of providers, each with relevant tasks and input into the treatment process. In the case of ovarian cancer, the gynecologic oncologist is often a key decision maker, but many others are also involved in developing a treatment plan that they all need to implement together.
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Rather, an accumulation of studies and the replication of findings, often culminating in a rigorous systematic review of the literature, is required. Individual systematic reviews are often conducted by groups of investigators; for example, the Cochrane Collaboration provides a system to summarize evidence and findings from multiple sources (Cochrane, 2015)
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Through its review of the evidence, the committee identified the following key messages and interventions ready for immediate dissemination 2 For more information, see http://www.cdc.gov/cancer/knowledge (accessed September 1, 2015)
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• All women with invasive ovarian cancer should receive germline ge netic testing; genetic counseling and testing are also recommended for the first-degree relatives of women with a hereditary cancer syndrome or germline mutation (i.e., cascade testing)
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cancers Genetic testing Ask your provider Request testing Refer patients Use testing results Support testing Testing is relevant (Rec.
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The time of diagnosis is a teachable moment for a woman to contact her family and discuss medical information, genetic counseling and testing, and risk reduction options, if appropriate. For families of women in active treatment for ovarian cancer, understanding and planning for the long-term nature and commitment of such treatment is critical to improving the health of everyone involved with care.
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Advance care planning is meant to inform primary care providers about care preferences, but these plans are often inadequate and are not yet in full use. Requiring advance care planning at all accredited hospital and clinical facilities is one possible strategy, but the quality and content of such plans varies considerably, as does their ability to inform providers about the need for specific care over time.
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Companies that market genetic testing often participate directly in research, working with academicians and clinicians to develop clinically meaningful tests and methods of implementation. Insurance industry representatives need to be aware of new recommendations for evidence-based treatments and technological applications for ovarian cancer.
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The committee identified a number of important messages for D&I, including messages about an improved under standing about the heterogeneous nature of ovarian cancers, the origins of these tumors, the value of genetic counseling and testing in high-risk women, and the effectiveness of standards of care. As discussed previously, the committee identified key messages that are ready for immediate D&I (see Table 7-1)
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The committee concludes that the while the knowledge base on ovarian cancers has advanced, key stakeholder groups (e.g., patients, families, providers, policy makers, advocates, researchers, and the media) are not receiving important messages that could influence patient outcomes.
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. Community Preventive Services Task Force.
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2014. Expanding access to BRCA1/2 genetic counseling with telephone delivery: A cluster randomized trial.
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Pittsburgh, PA: National Consensus Project for Quality Palliative Care. NRC (National Research Council)
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USPSTF (U.S. Preventive Services Task Force)
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