Primary care clinicians are ideally suited to provide comprehensive, whole-person survivorship care for cancer survivors that focuses on managing co-occurring chronic conditions and mitigating risks related to the cancer and long-term effects of the disease and its treatment. It is therefore critical to develop and test innovative strategies to support primary care practices in delivering high-quality survivorship care. The National Cancer Institute-funded Primary Care Engaged Research for Cancer Survivorship Care (PERCS) initiative encompasses 4 randomized controlled trials funded by cooperative agreement (U01) grants that aim to develop and test primary care practice-and health system-level interventions to promote comprehensive survivorship care for adult cancer survivors during and/or after cancer treatment. Here, we outline the overall goals of the PERCS initiative, describe key features of each study, and explore opportunities for leveraging synergies and collaboration with the overall goal of improving care and outcomes for all survivors.

PURPOSE:Over 70% of cancer survivors also have chronic conditions requiring coordinated care throughout survivorship. Few intervention studies have focused on improving care coordination between oncology and primary care during active treatment, specifically among under- and uninsured survivors. This study evaluated the effectiveness of Project CONNECT, a system-level intervention using an EHR-based registry and an oncology nurse coordinator, in improving patient-reported care coordination among breast and colorectal cancer survivors with at least one chronic condition seen in a large, urban, safety-net health system. METHODS:Using a pre-post quasi-experimental design, 294 patients diagnosed with stage I to III breast or colorectal cancer and ≥1 chronic condition were administered a telephone survey before intervention and 6 and 12 months after intervention to measure patient-reported care coordination. Summary statistics described patient characteristics, and generalized estimating equation assessed adjusted population-average changes in care coordination. RESULTS:The mean age of eligible patients was 56 years (standard deviation = 9.54). The majority of the survivors were women (78.6%). Race/ethnicity distribution of the sample represented the patient population of the safety-net health system with 45% White, 34% Black, and 51% Hispanic. Nearly 80% had ≥1 chronic conditions. After the intervention, patient-reported care coordination scores demonstrated significant improvement (β = -.05, P = .016). Notably, the proportion of survivors reporting never or rarely receiving confusing or differing information about their health or treatments decreased by 11% after the intervention. CONCLUSION:An EHR-based registry of cancer survivors with chronic conditions supported by an oncology nurse coordinator assisting survivors to establish or maintain primary care during active cancer treatment is a promising strategy to bridge the transition between oncology and primary care for cancer survivors receiving care in a safety-net heath system.

Background: Lung cancer screening (LCS) with low-dose CT (LDCT) remains markedly underutilized. Prior studies suggest that perceptions regarding LCS may influence intention to undergo LDCT; however, little is known about these beliefs and behaviors in vulnerable populations. We examined LCS-related health beliefs and LDCT completion in an urban safety-net health care system. Patients and Methods: We surveyed English- and Spanish-speaking individuals between February 2017 and February 2019 who had been scheduled for, but had not yet undergone, an initial LDCT. Survey items were adapted from validated measures, including the Lung Cancer Screening Health Belief Scales and the Lerman Breast Cancer Worry Scales, to assess LCS-related beliefs and lung cancer-related worry. We examined associations between these factors and LDCT completion using 2-sample t tests and chi-square tests. Results: Among 447 eligible individuals, 411 participated in the survey (71% from racial/ethnic minoritized groups), of whom 339 (82%) completed the initial LDCT. Almost half believed that they were at risk for lung cancer in their lifetime, and >90% believed that LCS would help find lung cancer early. Higher self-efficacy scores and lower perceived barriers scores were associated with LDCT completion (P=.002 and P=.004, respectively). Perceived risk and benefit scores were not associated with LDCT completion. Individuals who did not complete the first LDCT were more likely to note fear of lung problems (33% vs 18%; P<.001), stigma related to lung cancer (33% vs 17%; P=.008), and worry affecting mood (77% vs 64%; P=.02). Conclusions: In a diverse, real-world LCS population, most patients believed that LCS facilitates early detection of lung cancer; however, approximately 20% did not complete the initial LDCT. Perceived fear, stigma, and negative emotional responses to a potential lung cancer diagnosis were associated with lower LDCT completion rates. These findings offer insight into potentially modifiable factors and future interventions to improve LCS uptake among eligible individuals.

BACKGROUND:Guidelines for management of abnormal cervical cancer screening results have increased in complexity over the past two decades. Little is known about how patient-, clinician-, and organization-level factors influence implementation when guidelines change. Process mapping may offer insights into organizational processes and facilitate visualization for potential intervention opportunities. METHODS:We conducted an iterative multimodal qualitative assessment to compare abnormal cervical cancer screening management between two health systems: a safety-net institution and an integrated health system. We interviewed clinicians and staff to generate (phase I, May 2019-March 2021) and validate (phase II, July-Oct 2022) process maps at both systems. We conducted a rapid and thematic content analysis and engaged clinical and nonclinical stakeholders during interpretation. RESULTS:At both health systems, process maps informed by phase I participants (n = 31) identified a gap in care during patients' transition back to primary care following resolution of abnormal tests by gynecologists. In phase II, participants (n = 21) validated and revised maps, noting guideline updates and quality improvement initiatives. Although each system deployed unique strategies to address gaps in care, strategies in common included creating electronic health record-based clinical decision support tools, enabling gynecologists to provide real-time e-consults to primary care clinicians, and engaging patients via the portal. CONCLUSIONS:The complexity of cervical cancer screening management guidelines elevates the importance of identifying system-level tools to support clinician decision-making and coordinate between primary and specialty care teams. IMPACT:Process maps are valuable in generating cross-system comparisons by documenting clinical workflows, identifying care gaps, and engaging participants in formulating potential interventions.

PURPOSE:The literature reports patient perspectives on emergency department (ED) use during cancer treatment. Despite provider and policy interest in reducing ED visits for these adult patients, there are no reports of clinician perspectives on ED care. METHODS:We conducted a qualitative study of semi-structured clinician interviews from 2018 to 2022. We interviewed nine ED and 12 safety-net oncology clinicians from the University of Texas Southwestern and its academically affiliated but clinically distinct safety-net-Parkland Health. We investigated perspectives on acute care needs and ED overuse, analyzed with the constant comparative method. RESULTS:ED physicians had varying definitions of ED overuse but did not consider visits for pain, nausea/vomiting to qualify. Instead, there was concern for ED visits by patients near the end of life and who were unlikely to meaningfully benefit from hospital care. ED physicians exclusively relied on the oncology consult team for advice (staffed in part by oncology physician trainees), were unsure how to reach outpatient oncologists, and were unaware of an oncology urgent care clinic at their health system. Oncology physician trainees reported no formal training on triaging acute complaints, and variable familiarity with oncology urgent care. Oncology clinicians also did not view patients as overusing the ED, even for conditions due to chemotherapy effects. CONCLUSION:We captured under-recognized facets of acute care delivery, especially limited contact between two important teams-emergency medicine and oncology. Contrary to policy perspectives, ED and oncology clinicians did not consider visits for chemotherapy complications to represent ED overuse.

Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.

The current oncology workforce is struggling to keep up with demands for care. To address this shortage at The University of Kansas Cancer Center, we are educating the next generation about the breadth of careers at cancer centers. We describe the impetus for and process of developing an engaging infographic, “Charting the Course: Careers Along the Cancer Journey,” designed to resonate with high school students but which has also shown strong engagement and relevance among middle school students. The goal was to create a visual tool that not only illustrates the path of a cancer patient’s journey, but also highlights the various careers a cancer patient might encounter along the way. Ultimately, our aim is to build a comprehensive oncology workforce that is representative of the population we serve, thus educating the next generation of the oncology workforce and improving the health of our community at large.

The prevalence of cancer among patients accessing primary care in federally qualified health centers (FQHCs) is poorly characterized. A patient’s history of cancer in addition to common chronic conditions makes providing comprehensive primary care more complex, especially for patients accessing care at FQHCs who often face additional social and economic barriers to care. Trained auditors conducted a comprehensive electronic medical record audit using a standardized abstraction form to identify cancer history in patients aged ≥ 40 years with two common chronic conditions (diabetes and/or hypertension) and who had at least one visit to an FQHC between January 1 and December 31, 2019. Descriptive statistics were performed. Among 712 adult patients with diabetes and/or hypertension, 46 (6.46

BACKGROUND:Survivors of childhood, adolescent, and young adult cancers (CAYA) experience lifelong health risks and accelerated aging. We examined routine health care (no routine checkup in the past year) among a nationally representative sample of CAYA survivors at different life stages. METHODS:We pooled data from the Behavioral Risk Factor Surveillance System (BRFSS; 2012, 2014, 2016-2019). CAYA survivors (ages 0-39 at cancer diagnosis) were young adults (18-39 years), middle-aged (40-64 years), or older adults (≥ 65 years) at the time of the survey. We estimated the prevalence of: (1) not receiving routine health care and (2) not having a personal doctor, overall and by age at survey. We used multivariable Poisson regression to identify factors associated with these outcomes. RESULTS:We identified 4284 CAYA survivors: 884 young adults, 2201 middle-aged, and 1199 older adults. More young adults were uninsured and unable to afford care, compared to other age groups. A higher proportion of young adults did not receive routine health care (35.9%, 95% CI 30.3-41.9) or have a personal doctor (25.6%, 95% CI 20.5-31.4), compared to middle-aged or older CAYA survivors (p < 0.01). In multivariable models, being a young adult was strongly associated with (1) not receiving routine health care (aPR 1.82, 95% CI 1.24-2.67) and (2) not having a personal doctor (aPR 3.14, 95% CI 1.84-5.35). CONCLUSIONS:Younger CAYA survivors experience a triple threat of chronic conditions, modifiable risks, and disconnection from routine health care. IMPACT:Early interventions to facilitate care transitions are needed.

BackgroundMost survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association’s Life’s Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors. ObjectiveThis study aims to assess provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD. MethodsProviders (physicians, nurse practitioners, and physician assistants) completed a survey to assess the acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology survey (performance expectancy, effort expectancy, attitude toward using technology, and facilitating conditions). Semistructured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Posttreatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess the acceptability of the AH-HA tool immediately after the designated study appointment. ResultsProviders (n=15) reported high overall acceptability of the AH-HA training (mean 5.8, SD 1.0) and tool (mean 5.5, SD 1.4); provider acceptability was also supported by the Unified Theory of Acceptance and Use of Technology scores (eg, effort expectancy: mean 5.6, SD 1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (eg, “It helps focus the conversation and give the patient a visual of continuum of progress”). Providers were more favorable about using the AH-HA tool for posttreatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 (SD 3.7) years posttreatment. Most survivors reported that they strongly agreed or agreed that they liked the AH-HA tool (n=231, 94.3%). A larger proportion of survivors with high health literacy strongly agreed or agreed that it was helpful to see their heart health score (n=161, 98.2%) compared to survivors with lower health literacy scores (n=68, 89.5%; P=.005). ConclusionsQuantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Trial RegistrationClinicalTrials.gov NCT03935282; http://clinicaltrials.gov/ct2/show/NCT03935282 International Registered Report Identifier (IRRID)RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808

Primary care clinicians (PCCs) play a critical role in delivering comprehensive care to patients with chronic conditions, including cancer survivors. Community health centers (CHCs) serve as primary healthcare facilities, providing accessible and affordable care to underserved and vulnerable populations, including cancer survivors. Despite the essential role of CHCs, significant gaps remain in knowledge and research training regarding survivorship care within these settings. Given the rising population of cancer survivors in the United States, addressing these gaps is crucial to ensuring high-quality survivorship care. This study aimed to assess the barriers and facilitators PCCs encounter when providing survivorship care to cancer survivors with chronic conditions at CHCs. Qualitative in-depth interviews were conducted with PCCs from two healthcare systems, encompassing four urban CHCs in Texas during two phases. The research team developed semi-structured interview guides to explore barriers and facilitators in survivorship care. Interviews were conducted via phone or WebEX, a virtual platform, and were audio-recorded and transcribed verbatim by a certified transcription service. A team member reviewed the transcripts to ensure accuracy. Data were analyzed using an adapted immersion and crystallization approach, guided by the Chronic Care Model (CCM), to identify key themes related to survivorship care. Ten PCCs participated in the study. Qualitative analysis identified five key barriers to delivering high-quality survivorship care: (1) role ambiguity between PCCs and specialists, (2) inaccessibility of survivorship clinical guidelines, (3) limited communication between PCCs and oncologists, (4) inconsistent documentation of medical history, and (5) patient socioeconomic challenges, including financial difficulties. Pragmatic solutions were proposed to mitigate these barriers, and a patient-centered approach emerged as a key facilitator in improving care delivery. These findings highlight valuable opportunities to enhance survivorship care within CHCs by addressing identified barriers and leveraging facilitators to foster patient-centered, high-quality care for underserved cancer survivors. The utilization of the CCM framework provided deeper insights into the specific gaps and challenges PCCs face in CHCs. Maram Museitif, Bijal Balasubramanian, Gretchen H. Walton, Laura Aubree Shay, Hilary Ma, Simon Lee. Understanding clinician level barriers and facilitators to managing cancer survivors with chronic conditions at community health centers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4016.

12019 Background: Cardiovascular disease causes significant morbidity and mortality among US survivors. To enhance guideline recommended cardiovascular health (CVH) discussions during survivorship care, our team developed the EHR-based AH-HA clinical decision support tool, which displays modifiable CVH factors and cancer treatments with cardiotoxic potential. This tool significantly improved delivery of guideline-concordant CVH discussions, the primary study outcome; here we report AH-HA impacts on 12-month CVH improvements. Methods: The Wake Forest NCORP Research Base coordinated this practice-randomized clinical trial (NCT# 03935282) comparing AH-HA and usual care (UC) practices. Participants were survivors ≥ 6 months post-potentially curative treatment for breast, prostate, colorectal, endometrial cancers, or lymphoma, scheduled for routine follow-up. The AH-HA tool, based on the American Heart Association (AHA) Life’s Simple 7, aimed to enhance CVH awareness and action by providers and survivors. At AH-HA practices, providers used the tool with survivors during an outpatient oncology visit. CVH data were collected from the EHR and survivors (diet quality & physical activity) at baseline and 12 months. Outcomes included Simple 7 total CVH score (0-100, using AHA algorithm) and meaningful change in individual CVH factors (Table). Generalized estimating equations calculated rates of clinically meaningful improvements in CVH factors at 12 months by group, adjusting for cancer type and clustering within practice. Results: 645 survivors (82.3% breast cancer; 96.0% female; 83.9% white non-Hispanic, 7.8% Black, 3.7% Hispanic) enrolled at 9 practices (5 UC and 4 AH-HA). The total CVH score did not significantly change from baseline or between groups (Table 1, p>.05). Within the AH-HA arm, 20.3% of survivors achieved 5% weight reduction compared to 12.6% in UC; physical activity also improved more in the AH-HA arm, but not significantly. Rates were similar between arms for diet, blood pressure, and hemoglobin A1c. Conclusions: In addition to facilitating guideline concordant CVH discussions, AH-HA shows promise for encouraging weight loss among survivors. It is notable that a brief intervention delivered as part of standard oncology care impacted weight reduction. Clinical trial information: NCT03935282 . 12 month cardiovascular health outcomes among post-treatment survivors. CVH Outcomes AH-HA 4 practices, (n=281) Usual Care 5 practices, (n=342) Adj P-value Improvement, % Yes BMI (5% weight ↓) 20.3 12.6 0.02 Blood Pressure (5 mm ↓) 53.1 52.0 0.75 Physical Activity (+ 30 mins) 40.9 34.3 0.14 Healthy Diet Score (0-1 to 2-5, or 2-3 to 4-5 components) 21.7 18.9 0.45 Cholesterol (20% ↓) 8.6 9.6 # A1c (0.5% ↓) 8.9 8.8 0.97 Change in total CVH Score adjusted for baseline (positive=improvement) 0.9 -0.5 0.28 #Model did not converge due to small sample size.

In the United States, over 18 million individuals are living with cancer. The majority of these cancer survivors also manage other chronic conditions and receive care from multiple specialists, including oncology, cardiology, and primary care clinicians. However, it remains unclear who holds primarily responsibility for coordinating their care across specialties. Because of its generalist nature, primary care is uniquely suited to deliver whole-person and coordinated care for all conditions for cancer survivors. However, primary care teams experience many challenges delivering high-quality survivorship care. While integrating care for all conditions including cancer is a core principle of high-quality primary care, few survivorship care delivery interventions have been developed and tested among patients with a history of cancer in primary care panels of community health centers (CHCs). These under- and uninsured cancer survivors experience disproportionately worse health outcomes and often rely solely on CHCs for consistent health care. Community and Academic Synergy for Cancer Survivorship Care Delivery Enhancement (Project CASCADE) is a theory-driven pragmatic hybrid trial testing implementation and effectiveness of a multi-component primary care-based survivorship care delivery intervention among 8 Texas CHC sites. The specific aims are: Aim 1: Implement a system-level cancer survivorship care delivery intervention in partnership with CHC clinicians, patients, and community representatives, which includes: (1) primary care clinician training in cancer survivorship care through provider-to-provider tele-mentoring, (2) identification and tracking of survivors by modifying existing clinic workflows, and (3) coordinating survivors’ care by designating a care coordinator champion. Practice facilitation and stakeholder engagement strategies will support intervention implementation; Aim 2: Test the effectiveness of the intervention on patient (screening for second primary cancers) and clinician outcomes (clinician knowledge of and confidence in survivorship care) using a stepped-wedge clinic-randomized design; and Aim 3: Evaluate implementation using a mixed-methods approach guided by the Practice Change Model. We will utilize electronic health record (EHR), survey, interview, and observation data to assess effectiveness and implementation outcomes. Findings will inform a scalable, generalist primary care-based survivorship care model to enhance care delivery and outcomes in CHCs serving vulnerable populations. This study represents a critical step toward addressing gaps in cancer survivorship research and achieving equitable care for all survivors. This study is registered under clinical trial registration number NCT06883838; 2025–03-12.

BACKGROUND:For older adults to decide whether inguinal hernia repair will meaningfully improve their lives, it is critical to (1) understand how the operation affects them and whether it enhances outcomes that matter to them, and (2) identify ways to improve how surgeons discuss the benefits of surgery and how they prepare older adults for postoperative recovery. METHODS:We conducted semi-structured interviews with 40 Veterans ≥ 65 years old who had inguinal hernia repair at two high-volume Veterans Affairs hospitals. RESULTS:Participants were all men; their mean age was 73 years, 65% were White, and 33% were Black. Older adults felt that the surgical team provided excellent reassurance regarding the safety and efficacy of surgery but expressed a desire for improved listening during preoperative counseling and for clearer communication regarding the reality of postoperative recovery. Veterans reported a return to baseline physical and cognitive function between 2 days and 6 weeks after surgery, though two Veterans experienced significant short-term cognitive dysfunction. Those who reported dissatisfaction with preoperative communication were more likely to be surprised or concerned about postoperative symptoms. CONCLUSIONS:Our study provides critical information on how hernia repair affects the lives of older adults, and this can be used to better prepare the patients for surgery and to help them decide whether surgery will meaningfully enhance their quality of life.

INTRODUCTION:Adults often visit the emergency department (ED) for complications from cancer treatment. Oncology urgent care clinics (UCCs) can manage nonemergent issues, but little is known about how UCC care compares with ED care. METHODS:The authors' university hospital ED and UCC visits (January 1, 2023, through June 30, 2023) were analyzed after coding the Emergency Severity Index (ESI) for UCC visits to make them comparable to ED visits, where ESI was already regularly assigned. ESI ranges from levels 1 to 5 (1 = highest severity). Coarsened exact matching and multivariate models were used to compare the proportion of patients discharged home, the length of stay, and advanced imaging use. Marginally adjusted outcomes were stratified by ESI. RESULTS:Prior to matching, 31.7% of UCC and 64.0% of ED visits were ESI level 2 severity; 61.0% of UCC and 33.4% of ED visits were ESI level 3. Matching resulted in 1033 UCC and 2782 ED visits (61.0% of patients > age 65; 47.8% female; 65.9% non-Hispanic White). In adjusted analyses, for ESI level 2 visits, the UCC discharged patients home 32.0% more often than the ED (95% confidence interval [CI], 27.5-36.4), with a 7.0-hour shorter length of stay (95% CI, 6.5-7.5), and used advanced imaging 30.3% less often (95% CI, 26.0-34.7). Findings were similar for ESI level 3 visits. DISCUSSION:The UCC managed a high level of severity and may be more efficient than the ED for nonemergent care. CONCLUSION:Future work should more broadly investigate care delivery at each site, including the cost of care.

Despite the availability of a highly effective human papillomavirus (HPV) vaccine, uptake remains below Healthy People 2030 targets, particularly in rural areas where HPV-related cancers are more prevalent. This study aimed to explore how social processes influence parents' HPV vaccination decisions, focusing on vaccine-hesitant parents who vaccinated their child(ren) against HPV despite their hesitancy, eg, "hesitant adopters." We conducted a qualitative exploratory analysis of in-depth interviews with hesitant adopter parents (n = 8) to explore how social interactions with trusted interlocutors influenced their decision-making. Hesitant adopter parents identified relevant professional expertise, direct experience with the HPV vaccine, and social proximity to interlocutors as influential factors. We argue that rather than a single moment or decision, vaccination decision-making is a dynamic, ongoing process affected by social processes. This study adds nuance to our understanding of how prior vaccination behavior functions in future vaccine acceptance.

The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association’s Life’s Simple 7 cardiovascular health (CVH) metrics to promote CVH assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors. We assessed provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD. Providers (physicians, nurse practitioners, physician assistants) completed a survey to assess acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology (UTAUT) survey (Performance Expectancy, Effort Expectancy, Attitude Toward using Technology, and Facilitating Conditions). Semi-structured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Post-treatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess acceptability of the AH-HA tool immediately after the designated study appointment. Providers (n=15) reported high overall acceptability of the AH-HA training (mean=5.8, SD=1.0) and tool (mean=5.5, SD =1.4); provider acceptability was also supported by UTAUT scores (e.g., Effort Expectancy mean=5.6, SD=1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (e.g., It helps focus the conversation and give the patient a visual of continuum of progress). Providers were more favorable about using the AH-HA tool for post-treatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 years post-treatment (SD =3.7). Most survivors reported that they strongly agreed/agreed that they liked the AH-HA tool (94.3%, n=231). A larger proportion of survivors with high health literacy strongly agreed/agreed that it was helpful to see their heart health score (98.2%, n=161) compared to survivors with lower health literacy scores (89.5%, n=68; p=0.005). Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Assessing Effectiveness and Implementation of an EHR Tool to Assess Heart Health Among Survivors (AH-HA) NCT03935282 https://clinicaltrials.gov/study/NCT03935282?term=NCT03935282&rank=1 RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808

Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients.In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.

Background: Guidelines for managing abnormal cervical cancer screening results are complex and adherence is challenging for clinicians. Previous studies have identified gaps in knowledge as a possible cause; few have explored the confidence clinicians have in their management decisions. Confidence in decision-making may influence management practices, particularly when guidelines are complex and evolving. Objective: Assess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results. Design: A clinician survey used vignettes to ask clinicians to make a management recommendation for different abnormal results and rate their level of confidence in their response. Participants: Physicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts. Main Measures: Correct response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines. Key Results: In total, 501 clinicians completed the survey between October and December 2020 (response rate 53.7%). Overall, most clinicians made guideline-recommended management decisions for two vignettes (73.2 and 73.7%), but fewer were confident in their selection (48.3% and 46.6%, respectively). Clinicians who reported high levels of confidence were more often correct than those who reported lower levels of confidence (85.8% vs. 62.2% and 87.5% vs. 60.7%, both p<0.001). After adjusting for clinician and practice characteristics, confidence remained significantly associated with selecting the correct answer. Conclusions: Clinician confidence in management decisions for abnormal cervical cancer screening results was significantly associated with knowing guideline-concordant recommendations. Given the complexity of cervical cancer management guidelines, solutions to improve clinician confidence in decision-making are needed.