Translation of breast cancer survivorship evidence into primary care practice has relied on unidirectional oncology-centric approaches (e.g., care plans, guidelines) that fail to account for the realities of primary care delivery. Implementation challenges are exacerbated by difficulty identifying survivors and a lack of actionable guidelines for screening and treatment of late/long-term effects. Using principles of co-design to tailor implementation strategies has potential to produce actionable strategies for primary care delivery contexts. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, formative implementation mapping data were collected to inform the development of an interventional prototype to support primary care practices in providing survivorship care for patients with a history of breast cancer: Actionable Follow-up to Enhance suRvivorship in Breast Cancer (AFTER-BC). AFTER-BC is a primary care focused intervention that includes electronic health record (EHR) integrated tools to create a breast cancer survivor registry and screen for late and long-term effects of treatment. Twenty-six primary care practices were recruited from a large integrated health system with 13 randomized into the initial intervention arm. The AFTER-BC intervention included three virtual learning collaboratives with practice-level champions held over 12 weeks with ongoing bi-weekly virtual facilitation support. Throughout implementation, champions were prompted for feedback and suggestions which were integrated into the AFTER-BC prototype as appropriate and possible. More complex suggestions were documented for future refinement. In fielding AFTER-BC and incorporating end-user input to refine the intervention components, this study demonstrates the value of co-design principles for initial intervention delivery. For translational challenges where actionable strategies in the primary care context are lacking, creating responsive real-time feedback loops can enhance the contextual appropriateness of interventions. Registered with ClinicalTrials.gov on June 2, 2022: NCT05400941, https://clinicaltrials.gov/study/NCT05400941.
Fadem et al. (Sat,) studied this question.