Physical and Functional Improvement via Cancer Rehabilitation Triaging (PIVOT) Trial

Ann Marie Flores, PT, PhD, associate professor of Physical Therapy and Human Movement Sciences, with her MPI, Sofia Garcia, PhD, professor of Medical Social Sciences and director of the Cancer Survivorship Institute, received a $2.7 million dollar grant to study how to implement interventions that identify and triage cancer patients to ensure appropriate rehabilitation service delivery.

This is a new project, built on preliminary work the team conducted to implement routine patient-reported symptom and supportive care screening that is integrated into electronic heath records and clinical pathways in Northwestern Medicine oncology clinics.  

What are the aims of the project?

In brief, our aims are: 

1. Conduct a randomized controlled trial to test the efficacy of whether our novel and modern intervention identifies patients who need cancer rehabilitation in a timely manner and connects them to the right service - physical therapy, occupational therapy, or speech therapy - close to home. Most patients who need cancer rehabilitation need physical therapy, though some may require occupational or speech therapy instead. By providing precise clinical decision support, our intervention may also save time, effort and money for both patients and the health care system while removing obstacles to care such as specialist bottlenecks and under-referral. Our primary outcome is physical and functional impairment; secondary outcomes include health care utilization, health-related quality of life, and survival. We expect participants in the intervention arm to show improved outcomes compared to those who don't receive it. 
2. Our second aim gathers data to plan for future implementation and to assess the cost consequences of our intervention - we anticipate it may save health care dollars, patient and personnel time, and effort in the long run. 
3. Finally, we'll conduct secondary analyses examining how the intervention's effects vary across different predisposing and enabling factors. What works in one clinical workflow or health care system may not work in another, and this project will help clarify why. 

What are your next steps? 

After completing the study, our next step is to implement the intervention as standard of care for identifying and triaging cancer patients to ensure appropriate rehabilitation service delivery. 

What do you hope will come out of this funded research? 

We hope this research becomes a model for precision cancer rehabilitation care delivery that is impairment-centered, cancer-type agnostic and affordable. By teaming up with cancer care leaders, Northwestern Medicine Rehabilitation Services and others we believe this work aligns well with the health system's priorities of care excellence, patient satisfaction and guideline concordance while also meeting — and exceeding — accreditation standards in cancer care. We believe the intervention might remove critical bottlenecks — like low awareness, missed assessment opportunities, specialist bottlenecks and under-referral — while improving clinical workflows and care cultures to systematically and automatically support patients and providers in closing a major gap in cancer care.

We also hope to demonstrate that existing resources and direct access to rehabilitation therapies can be leveraged in new ways to inform expectations and improve referrals around cancer rehabilitation across our cancer patient populations and health care system. By breaking down siloed processes and connecting with outstanding cancer rehabilitation specialties in novel ways, we aim to close critical gaps in care that are vital to helping our patients not just survive, but thrive. We also expect our intervention to deliver much needed support for our busy oncology providers to monitor and make timely and appropriate cancer rehabilitation referrals to prevent and mitigate physical and functional impairments related to cancer and its treatment in support of their patients and families.  

Learn more about the project here.