Accepted for/Published in: JMIR Research Protocols
Date Submitted: Dec 16, 2019
Date Accepted: Oct 20, 2020
The Influence of PARAmedical Interventions on Patient ACTivation in the Cancer Care Pathway: Protocol for implementation of the PAM 13 (Paract multicentric study)
ABSTRACT
Background:
The increase in the number of cancer cases and the evolution of cancer care management have been generating a shift towards chronicity for many years. This phenomenon poses a significant problem for the French healthcare system. As a result, patient empowerment has been a long sought-after goal in chronic pathologies for several years. The Patient Activation Measure (PAM) was developed to assess the evolution of patients in this activation process. Indeed, patients with a high level of activation generally have less misguided use of healthcare and better treatment adherence. Therefore, the implementation of an activation measure via the PAM-13, in the course of the cancer care pathway, can potentially highlight the patient’s needs, with nursing care adapting accordingly.
Objective:
The objectives of the PARACT multicentric study are threefold: (i) to evaluate the implementation of the PAM-13 in oncology nursing practices in five Comprehensive Cancer Centers, (ii) to identify the obstacles and facilitators to the implementation of PAM-13 at the various sites, (iii) to produce recommendations for the dissemination of such interventions in other Comprehensive Cancer Centers.
Methods:
The implementation process will consist of three stages: 1/ First, we will conduct a robust pre-implementation analysis, using the Theoretical Framework (TDF) linked to the COM-B model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the ‘Behaviour Change Wheel’ (BCW), a strategy for implementing the PAM-13 will be personalized, depending on the specificities of each context. 2/ The second step is enrolling patients in the study. They will be included in the study for a period of 12 months. During his or her involvement, the patient care pathway will be studied and axes of nursing care will be collected. The primary goal is to implement PAM-13. The questionnaires will be completed three times in the course of one year: (i) at the time of the patient’s enrollment in the study (ii) at 6 months and (iii) at 12 months. 3/ Finally, at the end of the study period and patient follow-up, we will perform a post-implementation analysis through semi-structured interviews, using the TDF, to investigate implementation problems at each site. We will measure four implementation elements within the framework of RE-AIM.
Results:
This protocol was funded in August 2016 with support by the French Ministry of Health and Solidarity (DGOS) and the Lucien Neuwirth Institute of Cancerology of Saint- Etienne, France. Data collection for this study is ongoing.
Conclusions:
This implementation study in five French Comprehensive Cancer Centers would improve the implemented targeted nursing interventions, in order to offer the patient a personalized cancer care pathway. Furthermore, the measurement of the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Clinical Trial: ClinicalTrials.gov Identifier: NCT03240341 ANSM: 2017-A00235-48 IDRCB: 2017-A00235-48
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