Using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study
Year: 2023
Type: article
Abstract: BACKGROUND: Lung cancer screening is a complex clinical process that includes identification of eligible individuals, shared decision-making, tobacco cessation, and management of screening results. Adaptations to the delivery process for lung cancer screening in situ are understudied and underreported, with the potential loss of important considerations for improved implementation. The Framework for Reporting Adaptations and Modifications-Expanded (FRAME) allows for a systematic enumeration of adaptations to implementation of evidence-based practices. We applied FRAME to study adaptations in lung cancer screening delivery processes implemented by lung cancer screening programs in a Veterans Health Administration (VHA) Enterprise-Wide Initiative. METHODS: We prospectively conducted semi-structured interviews at baseline and 1-year intervals with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs) between 2019 and 2021. Using this data, we developed baseline (1st) process maps for each program. In subsequent years (year 1 and year 2), each program navigator reviewed the process maps. Adaptations in screening processes were identified, documented, and mapped to FRAME categories. RESULTS: We conducted a total of 16 interviews across 10 VHA lung cancer screening programs (n=6 in year 1, n=10 in year 2) to collect adaptations. In year 1 (2020), six programs were operational and eligible. Of these, three reported adaptations to their screening process that were planned or in response to COVID-19. In year 2 (2021), all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. These adaptations were planned and unplanned and often triggered by increased workload; 57% of year 2 adaptations were related to the identification and eligibility of Veterans and 43% were related to follow-up with Veterans for screening results. Throughout the 2 years, adaptations related to data management and patient tracking occurred in 60% of programs to improve the data collection and tracking of Veterans in the screening process. CONCLUSIONS: Using FRAME, we found that adaptations occurred primarily in the areas of patient identification and communication of results due to increased workload. These findings highlight navigator time and resource considerations for sustainability and scalability of existing and future lung cancer screening programs as well as potential areas for future intervention.
Institutions: Veterans Health Administration, VA Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Vanderbilt University, Vanderbilt-Ingram Cancer Center, United States Department of Veterans Affairs, Atlanta VA Medical Center, Phoenix VA Health Care System, Icahn School of Medicine at Mount Sinai, University of California, Los Angeles, VA Greater Los Angeles Healthcare System
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,990
Funders: Conquer Cancer Foundation, Bristol-Myers Squibb Foundation, LUNGevity Foundation, Bristol-Myers Squibb, American Society of Clinical Oncology, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Agency for Healthcare Research and Quality, Office of Rural Health, National Heart, Lung, and Blood Institute, National Cancer Institute, National Center for Advancing Translational Sciences
Awards: G1182793083, G129402337, G1722879731, G1761114649, G2209161966, G2615776415, G275963511, G3051419658, G3672902690, Understanding Provider Behavior in Lung Cancer Screening, G4333865332, G4425699080, G4513176822, G5132923919, G5253921404, G5679716143, G5681788397, G5853943267, G6087458142, Vanderbilt Scholars in T4 Translational Research (V-STTaR) Program, The Vanderbilt Institute for Clinical and Translational Research (VICTR), G8008953361, G825908784, G8275602555, G8950198931, G9000033427, G9000081609, Vanderbilt Institute for Clinical and Translational Research (VICTR), Cancer Center Support Grant
OpenAlex ID: W4315785010