Small LIVER Cancer: Development of a Multi-Level Intervention to Improve Access to CURE (LIVER:CURE)

Albert Einstein College Of Medicine, Bronx NY

Investigators

Abstract

The long-term objective of this K08 application is to develop Dr. Resmi Charalel’s capacity to discover practical solutions to reduce disparity in timely guideline concordant treatment for small hepatocellular carcinoma (HCC) patients, a cancer population where there is currently a large gap in care delivery from diagnosis to treatment. During the K08 award period, the proposed training activities will support Dr. Charalel in four educational and training objectives that will allow Dr. Charalel to develop into an independent investigator who is able to implement barriers and facilitators analyses, as well as stakeholder-engaged intervention development for timely small HCC treatment and ultimately, increase appropriate treatment utilization for small HCCs. First, Dr. Charalel will develop knowledge in qualitative research methods in order to investigate the barriers and facilitators to treatment for small HCCs using reliable and reproducible methods. Second, she will develop expertise in healthcare delivery research to better understand how to improve the care delivery pathway. Third, Dr. Charalel will develop expertise in implementation science by completing a rigorous certificate in Implementation Science including training in advanced trial methods important to test the efficacy of interventions as an independent investigator. Finally, Dr. Charalel will pursue professional development opportunities, specifically geared towards grant writing and collaboration. The three research aims of this project proceed as follows: Aim 1 will identify barriers and facilitators of treatment for small HCCs (less than 5 cm) using qualitative research methods. Specifically, Dr. Charalel will use focus groups of patients who did not receive timely treatment (within 3 months) and semi-structured interviews with providers and staff to develop a comprehensive understanding of the modifiable factors that contribute to treatment utilization. Aim 2 will focus on iterative development of a multilevel intervention to facilitate timely care to small HCC treatment in conjunction with a stakeholder advisory board. The multi-level intervention will address patient-level, provider/staff-level and system-level factors that contribute to gaps and inefficiencies in care delivery. Aim 3 will consist of a single arm, pilot feasibility and acceptability test of our multi-level intervention across the medical center to ensure broad reproducibility. We will also obtain preliminary effectiveness data by comparing treatment rates and time to treatment between our interventional cohort and historical controls. Collectively, the proposed training and research activities will generate essential preliminary data and investigator expertise necessary to support a future randomized controlled trial evaluating the effectiveness of the developed multilevel intervention in improving timely treatment for patients with small, potentially curable HCC. The proposed work aligns with the NCI Cancer Moonshot goal of improving cancer care delivery through the application and evaluation of current standards of HCC treatment.