Penn Implementation Science Center in Cancer Control (ISC3)

Led by CHIBE affiliated faculty Drs. Rinad Beidas, Justin Bekelman, and Robert Schnoll, the Penn Implementation Science Center in Cancer Control (ISC3) is a $4.9 million, 5-year grant from the National Cancer Institute that is part of the national network of ISC3s. The goal of this center is to apply insights from behavioral economics to rapidly accelerate the pace at which evidence-based practices for cancer care are deployed and the extent to which they are delivered equitably, thereby increasing their reach and impact on the health and health equity of individuals with cancer.

Penn ISC3 is composed of signature projects focused on increasing the uptake of several evidence-based practices:

• Tobacco use treatment: In a pragmatic trial testing patient- and clinician-directed EHR-based nudges, clinician nudges were associated with a near 3-fold increase in tobacco use treatment ordering compared to usual care. Results of this trial were published in Journal of Clinical Oncology in July 2023.
• Serious illness conversations (SICs): A trial tested patient- and clinician-directed EHR-based nudges to promote SICs among over 4,000 patients with cancer at high mortality risk. In a paper published in JAMA Network Open in July 2024, the combination of patient- and clinician-directed nudges was associated with a marginal increase in SICs.
• Supplemental screening for breast cancer: Supplemental screening with breast MRI may benefit patients with extremely dense breasts, as breast density is associated with increased cancer risk and reduced sensitivity for mammograms. In an ongoing pragmatic stepped wedge cluster randomized clinical trial (for which a protocol was published in Implementation Science in November 2023), EHR-based clinician nudges and text message-based patient nudges are being evaluated to promote breast MRI ordering and completion.
• Patient-reported outcome (PRO) monitoring: PRO monitoring is associated with improved symptoms and quality of life and reduced unplanned acute care for cancer patients, but real-world patient- and clinician-level adherence is suboptimal and inequitable. In this pragmatic trial, the Penn ISC3 team is testing whether upgraded workflows, patient reminders, automatic triage nurse alerts, and remote monitoring can boost PRO adherence.
• Genetic testing: Genetic testing is underused and implemented inequitably. In this 3-step sequential study, patient-directed nudges (deployed via the patient portal and text message) and clinician-directed nudges (deployed via a pended EHR order) are being assessed on their potential for promoting engagement with genetic testing. In November 2023, the study protocol was published in Implementation Science. 

Additionally, the center sponsors methods projects focused on refining implementation strategy design, conducting mixed methods analysis of potential implementation mechanisms, and centering our projects on equitable implementation. In 2024, methods project investigators published papers on addressing social needs in oncology care, strategies for implementing health information technology, guideline-concordant surgical care, and more. Projects are deployed across an implementation laboratory that spans Penn Medicine’s geographic footprint.

Penn ISC3 will produce new knowledge with the potential to reduce the research-to-practice gap in cancer care and improve outcomes equitably for millions of Americans with cancer.