The purpose of this Notice is to inform potential applicants to the National Cancer Institute (NCI) of special interest in research on the de-implementation of ineffective or low-value clinical practices, programs, treatments, or interventions ( practices ) along the cancer care continuum from detection to end-of-life. De-implementation research is broadly defined as the scientific study of factors, processes, and strategies for reducing, replacing, or stopping the use of ineffective or low-value clinical practices in healthcare delivery settings. Studies supported by this Notice should propose to use rigorous methods and study designs to better understand predictors, moderators, and mediators of de-implementation and/or test strategies to affect de-implementation processes and outcomes.

Background

Inappropriate use of certain practices may have a negative impact on patients (e.g., financial hardship, adverse side effects), healthcare providers (e.g., reduced clinical efficiency), healthcare teams (e.g., duplication of roles, failure of care coordination), healthcare organizations (e.g., poor resource utilization), and healthcare systems (e.g., administrative complexity and cost). Unfortunately, ineffective or low-value cancer-related practices are common at every point along the cancer care continuum, as evidenced by recent systematic reviews and international campaigns (e.g., Choosing Wisely). Further, waste in the U.S. healthcare system accounts for a significant portion of annual healthcare costs and is an inefficient use of limited resources. Overuse of low-value clinical practices, including (but not limited to) cancer-related practices, and continued use of ineffective practices contribute to waste in healthcare.

Efforts to reduce, replace, or stop the use of ineffective or low-value clinical practices are understudied. Emerging research suggests that de-implementing ineffective or low-value clinical practices may be different from implementing evidence-based practices, as de-implementation may be associated with unique barriers, facilitators, processes, and outcomes. A better understanding of de-implementation within healthcare is needed to inform real-world practice efforts to optimize patient health outcomes and maximize use of limited resources.

Research Objectives

NCI is interested in exploratory and/or hypothesis-driven R01 studies that will advance our scientific understanding of de-implementation of ineffective or low-value clinical practices in cancer care delivery. Applications in response to this Notice may propose to use a variety of study designs (e.g., observational, experimental, quasi-experimental, natural experiments, and pragmatic clinical trials) as well as a variety of research methods (e.g., qualitative, quantitative, mixed methods, social network analysis, and modeling) to better understand and impact de-implementation. Studies must focus on one or more phases of the cancer care continuum, including detection, diagnosis, treatment, survivorship, and/or end-of-life. Studies are encouraged to examine multilevel aspects of de-implementation, as well.

Research encouraged through this Notice includes (but is not limited to) studies that propose to:

• Explore patient-, provider-, team-, healthcare organization-, and healthcare system-level factors associated with de-implementation.
• Understand how de-implementation predictors, processes, and outcomes may differ when seeking to reduce, replace, or stop the use of an ineffective or low-value clinical practice.
• Understand how de-implementation may differ based on type of ineffective or unproven clinical practice (e.g., screening test, diagnostic test or procedure, medication, surgical procedure) and/or phase along the cancer care continuum, including detection, diagnosis, treatment, survivorship, and/or end-of-life.
• Develop and validate instruments to measure de-implementation factors, processes, and outcomes;
• Develop and test multilevel strategies to facilitate the de-implementation of ineffective or low-value clinical practices.

Application and Submission Information

This notice applies to due dates on or after March 6, 2020 and subsequent receipt dates through May 10, 2022.

• The following funding opportunity announcements (FOAs) or their reissued equivalents must be used for submissions for this initiative.

• All instructions in the SF424 (R&R) Application Guide and the listed funding opportunity announcements must be followed.
• For funding consideration, applicants must include "NOT-CA-20-021" (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.