Dissemination and implementation of DIGEST™ as an evidence-based measurement tool for dysphagia in cancer

传播和实施 DIGEST™ 作为癌症吞咽困难的循证测量工具

基本信息

批准号：
10584824
负责人：
Katherine Arnold Hutcheson
金额：
$ 69.88万
依托单位：
UNIVERSITY OF TX MD ANDERSON CAN CTR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-15 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584824
关键词：
Address Adopted Adoption Adverse event Affect Agreement Aspiration Pneumonia Barium swallow Bolus Infusion Cancer Survivor Cancer Survivorship Caregivers Caring Cessation of life Characteristics Choking Clinic Clinical Clinical Practice Variations Clinical Trials Collection Common Terminology Criteria for Adverse Events Complement Consolidated Framework for Implementation Research Data Data Set Decision Trees Deglutition Deglutition Disorders Development Diagnostic Dissemination and Implementation Dose Eating Effectiveness Enteral Feeding Environment Esophagus Evaluation Evidence based practice Exercise Focus Groups Food Frequencies Fright Funding Goals Head and Neck Cancer Health Health system Healthcare Systems Image Individual Injury Institution International Knowledge Language Length of Stay Liquid substance Longevity Malignant Neoplasms Malnutrition Measurement Measures Medical Medical Care Costs Methodology Methods Muscle National Cancer Institute Oncology Outcome Outcome Measure Pathologist Patient-Focused Outcomes Pattern Penetration Pharyngeal structure Physiological Pneumonia Population Population Heterogeneity Prevalence Protocols documentation Psychometrics Publishing Quality of life Radiation Dose Unit Randomized Reporting Reproducibility Research Research Peer Review Research Personnel Resources Safety Services Severities Site Speech Structure Supportive care Surveys Time Toxic effect Training Programs Uncertainty United States Validation Work arm aspirate cancer care care outcomes clinical care clinical decision-making clinical practice contextual factors daily functioning design dietary restriction dissemination science effectiveness evaluation evidence base food preparation functional status implementation science implementation strategy improved mortality mortality risk personalized care programs radiological imaging research to practice response routine practice scale up secondary analysis tool uptake

项目摘要

ABSTRACT Dysphagia (difficulty swallowing) is a highly prevalent and impactful condition with significant burden on the healthcare system. Across the lifespan, dysphagia is associated with excess risk of mortality, increased length of stay, aspiration pneumonia, and malnutrition thereby elevating medical costs and resource utilization. Not only a health problem, dysphagia also adversely affects quality of life and daily function with disproportionate impact on cancer survivors. Adoption of evidence-based methods into clinical practice lags decades behind discovery. One such gap is adoption of evidence-based practices (EBP) by speech-language pathologists in dysphagia management. Evidence-based dysphagia care begins with evidence-based swallowing evaluation. Significant progress has been made in the field of dysphagia to develop evidence-based evaluation methods, with particular emphasis on physiologic characterization of swallowing. The relative safety and efficiency of swallowing, that is how well a food or liquid bolus is kept out of the airway and clears fully through the pharynx into the esophagus, is a fundamental driver of clinical decision making – yet, remains inconsistently assessed and reported in clinical practice. To address this gap, the investigators’ developed DIGEST™ (Dynamic Imaging Grade of Swallowing Toxicity). DIGEST is an EBP tool to grade the severity of pharyngeal dysphagia based on results of a radiographic (videofluoroscopic) modified barium swallow (MBS) study. DIGEST uses a basic flowsheet and rubric (available open access via PMC) to summarize the patterns of penetration/aspiration and pharyngeal residue observed on the MBS as markers of swallowing safety and efficiency. DIGEST is a pragmatic yet robust measure validated in the head and neck cancer population, and adopted into routine practice at the PI’s institution with over 11,000 MBS graded in the clinic using the methodology since development in 2016. Peer-reviewed research shows adoption of DIGEST in external academic medical settings and federally funded clinical trials. Despite this promise, several obstacles still limit widespread adoption in routine cancer care. These include scalability to fit diverse clinical contexts outside the PI’s environment and uncertainty about best implementation strategies. The long-term goal of this project is to improve dysphagia care and patient outcomes through reliable adoption of DIGEST into routine clinical practice. Our central hypothesis is that DIGEST scales-up maintaining validity in diverse cancer populations under common clinical practice variations with reliable adoption facilitated by an active implementation strategy. The objective of this application is to use dissemination and implementation (D&I) science to accomplish the following Specific Aims: 1) demonstrate validity of DIGEST in diverse oncology populations and imaging acquisition protocols, 2) examine context and fidelity of natural dissemination of DIGEST in real-world, early adopters, and 3) evaluate active implementation strategies to improve reach and fidelity of DIGEST in clinical practice. With dense multi-site networks and content expertise, the investigators are uniquely equipped to conduct the proposed D&I project. We expect this work to improve care by narrowing the research-to-practice gap in dysphagia diagnostics.

抽象的吞咽困难（吞咽困难）是一种高度普遍且有影响力的状况，对医疗保健系统。在整个寿命中，吞咽困难与死亡率过多，长度增加有关住院，吸气性肺炎和营养不良，从而提高医疗成本和资源利用率。不仅一个健康问题，吞咽困难还会不利地影响生活质量和日常功能，影响不成比例关于癌症存活。将基于证据的方法采用临床实践落后于发现的数十年。这样的差距之一是吞咽困难中语言病理学家改编基于证据的实践（EBP）管理。基于证据的吞咽困难始于基于证据的吞咽评估。重要的在吞咽困难领域取得了进展，以开发基于证据的评估方法强调吞咽的物理表征。吞咽的相对安全性和效率，即食物或液体推注的含量如何，并通过咽部完全清除食管，是临床决策的基本驱动力 - 然而，在临床上仍然不一致地评估和报告实践。为了解决这一差距，调查人员的开发了Digest™（吞咽的动态成像等级毒性）。 Digest是根据A的结果对咽吞咽困难进行评分的EBP工具射线照相（视频荧光镜）修饰的钡燕子（MBS）研究。 Digest使用基本的流程图和标题（可通过PMC开放访问）来总结穿透/抽吸的模式和咽在MBS上观察到的残留物是吞咽安全性和效率的标记。摘要是一种务实而强大的在头部和颈部癌的人群中验证的措施，并在PI机构中采用常规实践自2016年开发以来，使用该方法在诊所中分级超过11,000 MB。研究表明，在外部学术医疗环境和联邦资助的临床试验中采用了摘要。尽管有希望，但几个障碍仍然限制了常规癌症护理中的宽度采用。这些包括适合潜水员临床环境以外的潜水员的可伸缩性以及最佳实施的不确定性策略。该项目的长期目标是通过可靠的将摘要采用到常规临床实践中。我们的中心假设是消化缩放维护在常见的临床实践变化下采用可靠的采用量通过积极的实施策略。本应用的目的是使用传播和实施（D＆I）科学以实现以下具体目的：1）在潜水肿瘤学人群和成像采集方案，2）检查环境和自然的保真度在现实世界，早期采用者和3）评估主动实施策略中传播摘要在临床实践中提高覆盖范围和消化性。具有密集的多站点网络和内容专业知识，调查人员在执行拟议的D＆I项目方面非常等同于。我们希望这项工作能改善通过缩小吞咽困难诊断的研究对实践差距来护理。