Method to engage invested partners to co-create feasible and sustainable approaches to design and implement cancer...

A core tenet of implementation science is early planning for implementation with invested partners. For health systems, aligning workflows and strategies to the local context and ensuring that the intervention's change mechanism meets local priorities are critical for successful implementation. This paper describes a participatory engagement method to design and adapt cancer prevention and control tools (interventions) to promote whole-health and aligned workflows and strategies, focusing on health equity, termed Co-creation for health equity (CO-4 Health Equity). We illustrate this novel method with primary care (prevention) and oncology (treatment) case examples.

The CO-4 Health Equity method included a set of parallel online workshop sessions with clinic providers/staff and patient partners. This method is guided by the Core Functions and Forms approach to the implementation of complex interventions. That is, we actively worked with partners to co-create clinical workflows and other activities (i.e.,. the intervention's forms) that were tailored to clinical contexts, while preserving the intervention's core function(s), linked to how the intervention brings about change. Through four to five sessions, participants identified and refined the intervention's core purposes (functions) to ensure alignment with clinic priorities. Sessions focused on refining and adapting concrete forms (how) to meet those functions, such as clinical workflows and implementation strategies. We used similar co-creation methods in primary care and oncology settings.

In primary care and oncology, patients and clinical partners with diverse roles across clinics (e.g., clinicians, nurses, care managers, medical assistants, operations leaders, and electronic medical records informaticists) participated in 45-90-minute co-creation workshops. Sessions with clinic partners (n = 13 primary care partners; n = 15 oncology partners) and patients (n = 5 primary care patients; n = 7 oncology patients) were held separately and included summaries of patient recommendations and vice versa. Sessions focused on: (1) refining the core goals of each tool (e.g., identifying patients' priority cancer risk factors); (2) refining and adapting the workflows and strategies for intervention delivery; (3) user testing of tool prototypes; and (4) consensus-building on options for clinical workflows. We used iPRISM webtool for implementation planning, and developed matrices to track actions taken in response to partner recommendations.

This CO-4 Health Equity methodology leverages input from invested partners to refine and adapt workflows and strategies for implementing cancer prevention and control tools in primary care and oncology settings. Future directions include further testing this participatory methodology and applying it to other clinical innovations to increase health equity.