Background
Objective
Methods
Implementation intervention development
Implementation intervention evaluation
Evaluation approach
Measures
Analysis
Results
The implementation intervention
Step 1. Define problem in behavioral terms
Step 2. Select target behavior
Step 3. Specify target behavior
Step 2 | Step 3 | |
---|---|---|
Select target behavior | Specify target behavior | |
Consider |
Who?
| Urologist |
What?
| Clinical trial as a treatment option | |
When?
| Prior to treatment decision | |
Where?
| At location of results review | |
How often?
| At each cancer diagnosis | |
With whom?
| Each diagnosed cancer patient | |
Counsel |
Who?
| Urologist |
What?
| Clinical trials are a treatment option | |
When?
| At first treatment counseling visit | |
Where?
| In the exam room | |
How often?
| Every initial cancer treatment counseling visit | |
With whom?
| All patients meeting broad eligibility criteria (determined by flow sheet) | |
Refer |
Who?
| Urologist |
What?
| Signal to patient and cancer program that patient is recommended for clinical trial eligibility screening | |
When?
| During and immediately following treatment counseling visit | |
Where?
| Exam room and location where charting is performed | |
How often?
| Each time clinical trial is included in treatment counseling | |
With whom?
| All patients meeting broad eligibility criteria (determined by flow sheet) who do not refuse referral | |
Notify |
Who?
| Urologist or designated clinic staff |
What?
| Cancer patient is scheduling visit for clinical trial eligibility screening | |
When?
| At patient’s convenience in next 3 weeks | |
Where?
| Immediately following treatment counseling visit | |
How often?
| Each time referral is documented | |
With whom?
| All patients meeting broad eligibility criteria (determined by flow sheet) who do not refuse referral |
Step 4. Identify determinants of behavior
Step 5. Identify intervention options
Step 4 | Step 5 | Step 6 | ||||
---|---|---|---|---|---|---|
Determinants of referral | Intervention options | Content and implementation options | ||||
COM-B
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TDF
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Intervention functions
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Policy categories
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Behavior-change techniques
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Mode of delivery
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Also addressed in …
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Capability |
Knowledge
| Education, training, modeling | Communication/marketing | Commitment, social support (practical), instruction on how to perform the behavior, information about social and environmental consequences, demonstration of the behavior, information about others’ approval, credible source, material reward, framing/reframing | Continuing education workshop: Expanding Treatment Options for Urological Cancer Patients, Professional society offering delivered by physician champion and endorsed by South Central Section of the AUA, Clinical trial flow sheet | Toolkit website |
Review outcome goals, Feedback on outcomes of behavior, social support (emotional), instruction on how to perform the behavior, information about social and environmental consequences, information about others’ approval, credible source, social reward, identification of self as role model | Quarterly Newsletter featuring AUA president endorsement, trial briefs, Why I Do This segment, Meet the Cancer Center segment, and referral and accrual audit and feedback | Continuing education workshop, newsletter, toolkit website | ||||
Problem-solving, goal-setting, discrepancy between current behavior and goal behavior, self-monitoring of behavior, social support-unspecified, instruction on how to perform the behavior | Talking About Trials in-service curriculum | |||||
Prompts/cues, adding objects to the environment; instruction on how to perform behavior -non-specified; non-specified reward | Point-of-care interactive patient education table tent | |||||
Memory, attention and decision processes
| Enablement | Service provision, environmental/social planning | Prompts/cues | Available clinical trials’ point-of-care flow sheet | ||
Opportunity |
Environmental resources
| Service provision | Prompts/cues, restructuring social environment | Clinical trial referral prescription pad | ||
Prompts/cues, restructuring social environment | Cancer center “hotline” referral process | |||||
Restructuring social environment, adding objects to the environment, instruction on how to perform behavior (patient) | What this Trial Entails patient video series | |||||
Restructuring social environment, adding objects to the environment, instruction on how to perform behavior (patient) | Participating in a Cancer Clinical Trial patient brochure | |||||
Social influences
| Persuasion, environmental restructuring | Environmental/social planning, service provision | Social support (practical), restructuring the social environment, instruction on how to perform the behavior | Meet the investigator Breakfast/lunch | Continuing education workshop, newsletter | |
Motivation |
Social professional role and identity
| Enablement | Environmental/social planning, guidelines | Restructuring social environment | Referral role delineation | Continuing education workshop, toolkit website |
Feedback on outcome of behavior | Cancer center eligibility screening feedback | |||||
Feedback on outcome of behavior, information on how to perform the behavior, information about consequences | GU Trial Chart Note | |||||
Generalization of target behavior | Align role delineation with perceived roles and identity | |||||
Beliefs about consequences
| Incentivization, enablement | Education | Instruction on how to perform the behavior, information about social and environmental consequences, material incentive | Co-management discussion | ||
Prompts/cues, social reward, non-specific incentive | Branding through stationary, pens, brochures and media |
Step 6. Identify behavior-change techniques and implementation options
Implementation intervention evaluation
Response
Site A | Site B | Site C | Site D | |
---|---|---|---|---|
Organizational sponsor scope | State | State | State | Regional |
Meeting scope | 1 state | 2 states | 1 state | 8 US states, Mexico + Central America |
Placement on meeting agenda | Breakout | Plenary | No | Breakout |
Workshop location | On-site | On-site | Off-site | On-site |
Recruitment strategy | Letter | Letter | Letter | Program + meeting PR |
Number urologists invited | 104 | 0 | 84 | 2189 |
Incentive | US$50 | US$50 | US$50 | CME Credit |
Total meeting attendancea | 54 | 41 | N/Ad | 341 |
Workshop attendance | 10 (19%) | 13 (32%) | 9 (10%) | 35 (10%) |
Percent attendees non-academicb | 35% | 32% | 67% | 5% |
Behavioral intent to adopt | 10 | –c | 9 | 14 |
Implementation intervention appeal
Intervention acceptability and appropriateness
Average rating | Prior offer of clinical trials | No prior offer of clinical trials | Significance (p level) | |
---|---|---|---|---|
Acceptability | 4.4 | 4.6 | 4.2 |
p = 0.03
|
Appropriateness | 4.4 | 4.5 | 4.2 |
p = 0.24
|
n = 54 |