Advancing care coordination to enhance shared care for complex cancer survivors in primary care (ACCESS-PC): protocol for a hybrid type 3 effectiveness-implementation trial.
7 affiliations
- 1Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. [email protected].
- 2Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. [email protected].
- 3Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
- 4Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
- 5Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
- 6School of Public Health, Rutgers University, New Brunswick, NJ, USA.
- 7Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
Abstract
Background
Cancer survivors with chronic conditions (e.g., complex cancer survivors) are a growing population that faces greater cancer-specific and cardiovascular disease (CVD) related morbidity and mortality. A shared care model, which involves primary care and cancer clinicians, is the optimal care delivery model for complex cancer survivors. Yet, there is little guidance on how to effectively implement and support complex cancer survivors' continued engagement with primary care during the cancer treatment phase.Methods
This protocol describes a multi-phase, mixed methods, stakeholder-engaged research process that tailors and tests a multi-level health system intervention to improve primary care provider and cancer team 'shared care' for complex cancer survivors. This study employs a design-for-dissemination, theory-guided perspective, blending implementation science and care delivery conceptual frameworks: Exploration, Planning, Implementation, and Sustainment (EPIS) and Cancer Multi-team System (cMTS). These frameworks guide our understanding and strategies deployed on the multi-level factors of implementing shared care in a health system. Primary Care Connect (PCC) is a health system intervention designed to align complex cancer survivors, healthcare team members, and health system implementation actors' understandings, capacities, and practices to promote the adoption of shared care delivery models for complex cancer survivors. A hybrid type 3 effectiveness-implementation study design will test the effectiveness of PCC (n = 266 patients) in a patient-level randomized controlled trial on primary care connection, chronic disease management, and patient-reported outcomes. PCC implementation (e.g., feasibility, acceptability, and appropriateness) will be evaluated using a mixed methods approach to inform sustainable usage of the intervention. A concurrent learning evaluation will assess PCC's adaptations over time and convene health system stakeholders to explore intervention properties to inform adoption and sustainment considerations.Discussion
The overarching goal of this protocol is to examine whether cancer survivors becoming "lost in transition" is a preventable problem. PCC tests whether the challenge of transitioning patients back to primary care can be avoided altogether by re-engineering care coordination with primary care at the outset of cancer treatment. Study findings are poised to have a profound impact on the adoption of shared care delivery models throughout the U.S. to optimally mitigate complex cancer survivors' CVD risks.Trial registration
Registered with ClinicalTrials.gov on February 19, 2025: NCT06834204.
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BibTeX
@article{fadem2026advancing,
title = {{Advancing care coordination to enhance shared care for complex cancer survivors in primary care (ACCESS-PC): protocol for a hybrid type 3 effectiveness-implementation trial.}},
author = {Sarah J Fadem and Benjamin F Crabtree and Jennifer R Hemler and Kulwinder Dhaliwal and Pamela Ohman-Strickland and Jeanne M Ferrante and Shawna V Hudson and Denalee M O'Malley},
journal = {BMC primary care},
year = {2026},
month = jul,
doi = {10.1186/s12875-026-03484-2},
url = {https://europepmc.org/article/MED/42897469},
note = {CC BY},
}
RIS
TY - JOUR
TI - Advancing care coordination to enhance shared care for complex cancer survivors in primary care (ACCESS-PC): protocol for a hybrid type 3 effectiveness-implementation trial.
AU - Sarah J Fadem
AU - Benjamin F Crabtree
AU - Jennifer R Hemler
AU - Kulwinder Dhaliwal
AU - Pamela Ohman-Strickland
AU - Jeanne M Ferrante
AU - Shawna V Hudson
AU - Denalee M O'Malley
PY - 2026
DA - 2026/07/01
JO - BMC primary care
DO - 10.1186/s12875-026-03484-2
UR - https://europepmc.org/article/MED/42897469
AB - Background Cancer survivors with chronic conditions (e.g., complex cancer survivors) are a growing population that faces greater cancer-specific and cardiovascular disease (CVD) related morbidity and mortality. A shared care model, which involves primary care and cancer clinicians, is the optimal care delivery model for complex cancer survivors. Yet, there is little guidance on how to effectively implement and support complex cancer survivors' continued engagement with primary care during the cancer treatment phase.Methods This protocol describes a multi-phase, mixed methods, stakeholder-engaged research process that tailors and tests a multi-level health system intervention to improve primary care provider and cancer team 'shared care' for complex cancer survivors. This study employs a design-for-dissemination, theory-guided perspective, blending implementation science and care delivery conceptual frameworks: Exploration, Planning, Implementation, and Sustainment (EPIS) and Cancer Multi-team System (cMTS). These frameworks guide our understanding and strategies deployed on the multi-level factors of implementing shared care in a health system. Primary Care Connect (PCC) is a health system intervention designed to align complex cancer survivors, healthcare team members, and health system implementation actors' understandings, capacities, and practices to promote the adoption of shared care delivery models for complex cancer survivors. A hybrid type 3 effectiveness-implementation study design will test the effectiveness of PCC (n = 266 patients) in a patient-level randomized controlled trial on primary care connection, chronic disease management, and patient-reported outcomes. PCC implementation (e.g., feasibility, acceptability, and appropriateness) will be evaluated using a mixed methods approach to inform sustainable usage of the intervention. A concurrent learning evaluation will assess PCC's adaptations over time and convene health system stakeholders to explore intervention properties to inform adoption and sustainment considerations.Discussion The overarching goal of this protocol is to examine whether cancer survivors becoming "lost in transition" is a preventable problem. PCC tests whether the challenge of transitioning patients back to primary care can be avoided altogether by re-engineering care coordination with primary care at the outset of cancer treatment. Study findings are poised to have a profound impact on the adoption of shared care delivery models throughout the U.S. to optimally mitigate complex cancer survivors' CVD risks.Trial registration Registered with ClinicalTrials.gov on February 19, 2025: NCT06834204.
SN - 2731-4553
ER -