ECHO Model for Advanced Cancer Care Quality

Overseen By Sriram Yennu

Age: Any Age

Sex: Any

Trial Phase: Phase 2

Sponsor: M.D. Anderson Cancer Center

Disqualifiers: Unable to understand consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 27

312 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve cancer care in underserved areas by understanding the experiences and satisfaction of patients with advanced cancer and their caregivers. It employs the Project ECHO model (Project Extension for Community Healthcare Outcomes), which enhances local healthcare through education and support. Participants include patients receiving advanced cancer treatment, their primary caregivers, and healthcare providers interested in improving cancer care. Participants will complete surveys and interviews about their care experiences, while healthcare providers will engage in educational sessions. This trial suits patients and caregivers involved in advanced cancer care and healthcare providers eager to improve care quality.

As a Phase 2 trial, the research focuses on measuring the treatment's effectiveness in an initial, smaller group of people, offering participants a chance to contribute to meaningful advancements in cancer care.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the research team or your doctor.

What prior data suggests that the ECHO model is safe for improving cancer care quality?

Research has shown that Project ECHO is popular in many healthcare settings. This program enables local healthcare providers to learn from specialists through online meetings and workshops. It's important to understand that Project ECHO is not a drug or medical treatment. Instead, it aims to improve how healthcare is delivered and taught.

No safety concerns have arisen because it involves sharing knowledge, not providing direct medical treatment. Participants in Project ECHO programs typically gain better access to healthcare information without negative effects. Thus, joining this trial appears safe and focuses on enhancing healthcare delivery rather than introducing a new medication or procedure. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the ECHO Model for Advanced Cancer Care Quality because it aims to improve cancer care by enhancing communication and education. Unlike many traditional treatments that focus solely on medical interventions, this approach uses ECHO clinics to connect healthcare providers through online sessions and workshops, expanding their knowledge and skills. This method also involves patients and caregivers in regular feedback loops, offering insights into their experiences and satisfaction, which can lead to more personalized and effective care. By focusing on education and engagement, the ECHO Model has the potential to provide comprehensive support and improve the overall quality of care for cancer patients.

What evidence suggests that the ECHO model is effective for improving cancer care quality?

Research has shown that Project ECHO, which participants in this trial will engage with, improves healthcare by connecting experts with local doctors, particularly in resource-limited areas. This approach enables rural healthcare providers to acquire specialist knowledge through online meetings, enhancing patient care. Studies have found that this method increases access to advanced care and aids in the earlier diagnosis of complex health issues. Project ECHO has succeeded in various locations, from Uruguay to Brazil, facilitating access to care for people in remote areas. The program leads to better medical practices and more satisfied patients and caregivers, suggesting it could significantly enhance cancer care in the trial regions. ^{1 2 6 7 8}

Who Is on the Research Team?

Sriram Yennu

Principal Investigator

M.D. Anderson Cancer Center

Are You a Good Fit for This Trial?

This trial is for adult patients with advanced cancer and their caregivers in Kenya, Nigeria, Ghana, South Africa, India, and Ethiopia. Participants must be able to read English and have a life expectancy of at least one year. Caregivers need to be the primary support person. Healthcare providers interested in Project ECHO can also join if they commit for two years.

Inclusion Criteria

My caregiver is at least 18 years old.

I am willing to stay in touch with the research team by phone or in person.

Patient has a prognosis of at least 1 year as ascertained by the treating physician

Exclusion Criteria

I am able to understand and sign the consent form.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

ECHO Clinics and Workshops

Participants participate in online ECHO clinics over 1 hour twice monthly for 12 months and in-country workshops twice per year.

12 months

24 online sessions, 2 in-country workshops

Patient and Caregiver Assessment

Patients and caregivers complete questionnaires and interviews about their experience and satisfaction with care.

24 months

3 in-person or phone questionnaires every 3 months for patients; up to 8 questionnaires for caregivers

Follow-up

Participants are monitored for changes in quality of life and symptom distress.

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Project ECHO

Trial Overview The trial evaluates Project ECHO's impact on palliative care quality through telementoring clinics, workshops, education programs for oncologists, medical chart reviews, and questionnaires assessing patient/caregiver satisfaction in underserved areas.

How Is the Trial Designed?

Group I: Arm III: Caregivers (questionnaire) Experimental Treatment 1 Intervention

Caregivers complete an in-person or phone questionnaire over 5 minutes up to 8 times about their experience and satisfaction with the cancer care their family member has received. Caregivers complete a 15-minute interview in person or by phone their family member received by their physician.

Group II: Arm II: Patients (questionnaire, medical chart review) Experimental Treatment 2 Interventions

Patients complete 3 in-person or phone questionnaires over a total of 20 minutes every 3 months for 2 years about their symptoms, emotional and physical well-being, and their experience and satisfaction with outpatient oncology care. Patients' medical charts are reviewed for data collection. Patients complete a 15 minute interview in person or phone about the care they received by their physician at baseline, end of month 4 and month 12.

Group III: Arm I: ECHO Participants (ECHO clinics, workshop, education) Experimental Treatment 3 Interventions

Participants participate in online ECHO clinics over 1 hour twice monthly for 12 months and in-country workshops twice per year. Participants also receive 5 core lectures through an internet-based professional education curriculum.

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

A new conceptual framework has been developed to create quality indicators for end-of-life care in advanced cancer patients, focusing on improving pain management, symptom relief, and coordination of care.

The framework outlines five essential steps for developing these indicators, ensuring they are evidence-based, feasible, and relevant to the needs of seriously ill patients and their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A framework for assessing quality indicators for cancer care at the end of life. Seow, H., Snyder, CF., Mularski, RA., et al.[2009]

Project ADAPT aims to improve care coordination for patients with metastatic breast cancer (MBC) by implementing a collaborative care model across multiple community hospitals, ensuring that patients receive optimal care regardless of their location.

The study is currently in the exploration phase, having recruited 21 participants to refine the collaborative care process, with plans to enroll more patients and oncologists to evaluate the model's impact on referral satisfaction and overall care experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting and Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care (Project ADAPT): Protocol for an Implementation Science-Based Study. Housten, AJ., Okere, UC., Colditz, GA., et al.[2023]

Only 5.0% of patients with advanced solid tumors received outpatient specialty palliative care (OSPC) in 2016, highlighting a significant gap in access to these services.

Patients were 19 times more likely to use OSPC if their oncologist's practice was located in the same facility as the OSPC clinic, and those living closer (under 30 minutes) were also significantly more likely to access these services, indicating that clinic location and travel time are critical factors in OSPC utilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

System-Level Factors Associated With Use of Outpatient Specialty Palliative Care Among Patients With Advanced Cancer. Yu, JA., Ray, KN., Park, SY., et al.[2023]

Project ECHO is a knowledge dissemination platform designed to improve cancer care by increasing workforce capacity and sharing best practices, particularly in underserved communities.

The platform has been successfully implemented in various programs worldwide, demonstrating its potential to address disparities in cancer care, especially in low and middle-income countries facing a growing cancer burden.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. Varon, ML., Baker, E., Byers, E., et al.[2021]

Project ECHO is an effective model that enhances the skills and confidence of primary care clinicians through telementoring, allowing patients in underserved areas to receive high-quality care without long travel times.

A new replication tool developed for the ECHO model has successfully improved its implementation in the Army Pain initiative, suggesting it could enhance the fidelity of ECHO replications globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model. Katzman, JG., Galloway, K., Olivas, C., et al.[2022]

The Project ECHO model has been evaluated for its effectiveness in training healthcare professionals in underserved communities about cancer prevention and survivorship care, showing it is a feasible approach to enhance cancer control capacity.

Preliminary evidence suggests that this model can successfully democratize knowledge among health professionals, potentially improving cancer care in areas with limited resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Building Cancer Control Capacity in Health Professionals Through Telementoring: A Survey Study of a Cancer Prevention and Survivorship Care ECHO Program. Milgrom, ZZ., Severance, TS., Scanlon, CM., et al.[2023]

There is a significant lack of research on the unique needs of cancer survivors with advanced or metastatic cancer, highlighting the necessity for better understanding their physical and psychosocial symptoms.

The National Cancer Institute has identified key research areas to address these gaps, including improving symptom management, enhancing communication between healthcare providers and patients, and developing tailored survivorship care models.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Survivorship for Individuals Living With Advanced and Metastatic Cancers: National Cancer Institute Meeting Report. Mollica, MA., Smith, AW., Tonorezos, E., et al.[2022]

Patient-reported outcome measures (PROMs) can significantly enhance the care of metastatic breast cancer (MBC) patients by improving health-related quality of life (HRQoL) and balancing survival with quality of life, as identified by the Advanced Breast Cancer Global Alliance's goals for 2015-2025.

Nurses and nurse practitioners play a vital role in implementing PROMs in routine care, which can lead to better patient outcomes, including improved communication, access to support services, and meeting patients' informational needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice. de Ligt, KM., de Rooij, BH., Koppert, LB., et al.[2023]

The Project ECHO initiative successfully implemented a telementoring model for cancer care in Buenos Aires, evaluating 80 patients from 37 centers over 3 years, which helped improve access to expert medical knowledge for gastrointestinal tumors.

This approach not only reduced disparities in cancer care by facilitating multidisciplinary discussions but also proved to be cost-effective by minimizing unnecessary treatments and travel expenses for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of a virtual multicenter gastrointestinal tumor board to reduce cancer disparities in Argentina. Esteso, F., Tissera, NS., O'Connor, JM., et al.[2022]

Citations

1. cdc.gov cdc.gov/lab-quality/php/echo/index.html

Project Extension for Community Healthcare Outcomes The ECHO (Extension for Community Healthcare Outcomes) Project was designed to educate and train laboratory and healthcare professionals on ...

2. digital.ahrq.gov digital.ahrq.gov/ahrq-funded-projects/project-echo-extension-community-healthcare-outcomes

Project ECHO: Extension for Community Healthcare ... Project ECHO connects urban medical center disease experts with rural general practitioners and community health representatives over a telehealth network.

3. projectecho.unm.edu projectecho.unm.edu/

Project ECHO: Home Through Project ECHO, health care providers from Uruguay to Brazil are improving access to early diagnosis and advanced care for complex cases. Read More · El ...

4. mdanderson.org mdanderson.org/education-training/outreach-programs/project-echo.html

Project ECHO - Home Page Project ECHO® (Extension for Community Healthcare Outcomes) is a teleconsulting and telementoring partnership between MD Anderson specialists and providers ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10091128/

“Mind the Gap” - An overview of the role of the Extensions ... The aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated.

6. ahrq.gov ahrq.gov/patient-safety/settings/multiple/project-echo/index.html

Project ECHO | Agency for Healthcare Research and Quality A collaborative model of medical education and care management that helps clinicians provide expert-level care to patients wherever they live.

7. preventcancer.org preventcancer.org/wp-content/uploads/2018/11/20181106_0800_Arora.pdf

Project ECHO (Extension for Community Health Outcomes) At ECHO, our mission is to democratize medical knowledge and get best practice care to underserved people all over the world. Our goal is to touch the lives of ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4873719/

Project ECHO (Extension for Community Healthcare ... ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning.