BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/New_York X-LIC-LOCATION:America/New_York BEGIN:DAYLIGHT TZOFFSETFROM:-0500 TZOFFSETTO:-0400 TZNAME:EDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0400 TZOFFSETTO:-0500 TZNAME:EST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20250327T203345Z LOCATION:Frontenac Foyer DTSTART;TZID=America/New_York:20250401T164500 DTEND;TZID=America/New_York:20250401T181500 UID:HFESHCS_2025 International Symposium on Human Factors and Ergonomics i n Health Care_sess148_POST306@linklings.com SUMMARY:PS9 - Mapping Sustainability Strategies From Implementation Scienc e to Human Factors Work System Redesign Domains: Secondary Analysis From t he Cancer Center Cessation Initiative (C3I) DESCRIPTION:Poster Presentation\n\nEdmond Ramly (Indiana University); Reid Parks (Indiana University, University of Wisconsin - Madison); Mara Minio n (University of Wisconsin - Madison); and Magda Montague and Ramzi Sallou m (University of Florida)\n\nBackground:\nTobacco is the leading cause of preventable cancer with 40% of cancer diagnoses in the United States being attributed to tobacco use (Islami et al., 2018). Furthermore, continued s moking after cancer diagnosis is associated with significant increases in cancer-specific mortality, and all-cause mortality (Wang et al., 2019). As such, the National Cancer Institute (NCI) launched the Cancer Center Cess ation Initiative (C3I) with the goal of supporting cancer centers in build ing and implementing sustainable tobacco cessation treatment programs to p romote tobacco cessation among their current patients. \n\nStarting in lat e 2017, 52 cancer centers were selected to receive two years of funding to initiate or expand tobacco cessation treatment programs. At its core, C3I is an implementation effort, integrating evidence-based tobacco dependenc e treatment into cancer care workflows and utilizing electronic health rec ord technology to facilitate that integration (Croyle et al., 2019). Thus far, C3I-funded sites have collectively delivered tobacco cessation treatm ent to more than 50,000 patients with cancer who smoke, and more than doub led overall patient reach. While the C3I-funded tobacco cessation programs have been shown to be effective, little is known about strategies to sust ain them in the long term. \n\nThese cancer center work systems present un ique challenges related to organizational sustainability. Existing framewo rks including the systems engineering initiative for patient safety (SEIPS ), capture the need for ongoing adaptations to sustain work system outcome s as environments change (Carayon et al., 2006; Holden et al., 2013). Howe ver, specific strategies to support sustainability have yet to be generate d. \n\nRecent developments in the field of Implementation Science related to sustainability include sustainability determinants (barriers and facili tators to sustainability) frameworks such as the Clinical Sustainability A ssessment Tool (CSAT) and Program Sustainability Assessment Tool (PSAT). T he CSAT and PSAT are validated instruments for evaluating the sustainabili ty capacity of a clinical practice. This large national study within cance r cessation programs presents the opportunity to leverage expert opinions on sustainability guided both by the SEIPS model and these validated instr uments.\n\nThe purpose of this study was to develop a taxonomy of sustaina bility strategies to address the needs of these unique work systems. To ac hieve this goal, we leveraged the expertise of individuals who were involv ed in the initial development of the tobacco cessation programs across a v ariety of roles and sites. By focusing first on the CSAT domains of sustai nability, then reframing these strategies around work system needs, we aim ed to support sustainable tobacco cessation programs with expert-endorsed sustainability strategies.\n\nApproach:\nIn this secondary data analysis s tudy, sustainability strategies developed using a user-centered co-design process described below were deductively coded using the systems engineeri ng initiative for patient safety (SEIPS) 2.0 framework. Experienced qualit ative researchers dual-coded all strategies as one or more SEIPS 2.0 eleme nts.\n\nThe process by which the sustainability strategies data used in th is secondary analysis were generated was reported elsewhere and is summari zed as follows. A multidisciplinary team of researchers, clinicians, and cancer center administrators came together to form the Sustainability Work ing Group (SWG) (C3I Coordinating Center and Expert Advisory Panel, 2021). In accordance with the Delphi approach, 22 experts representing 16 insti tutions engaged in iterative conversations across multiple rounds to devel op, adapt, and reach consensus on strategies for the sustainment of existi ng tobacco cessation programs. Strategy development followed an iterative process consisting of 7 1-hour long sessions across 4 phases: ideation, so rting, refinement, and group and individual ranking. The ideation phase co nsisted of 3 sessions. This process was organized by the CSAT domains to e xplicitly target sustainability-focused strategies. This was followed by 2 sessions of sorting strategies into their corresponding CSAT domains. Nex t, the SWG spent 2 sessions revising and refining the list of strategies. The revised strategy list was reviewed by the group to reach consensus on importance and feasibility ratings for each strategy. Following the strate gy development process, individual SWG members were invited to review the group consensus scores and further provide their input by assigning new sc ores in a Qualtrics survey, informed by their expertise and the group scor es. Next, the survey was sent out to all C3I-funded sites with a request t o share the survey with individuals in a variety of roles at each site. \n \nResults:\nThe deductive analysis guided by SEIPS allowed for organizatio n of sustainability strategies by which work system component they targete d or leveraged: 27 were related to the “organization” component of the wo rk system, 18 were related to “tools & technology,” 13 were related to “ex ternal environment,” 10 were related to “person,” and 1 was related to “ta sks.” Paired with the results from the Delphi approach, there were 10 con sensus organization sustainability strategies, 8 consensus tools & technol ogy sustainability strategies, 5 consensus external environment sustainabi lity strategies, and 2 consensus person(s) sustainability strategies. No c onsensus strategies were identified targeting the task or internal environ ment components of the work system. \n\nHigh consensus on importance and f easibility of strategies did not necessarily indicate these strategies wer e important and feasible. Using the overall average importance and feasibi lity scores, 15 consensus sustainability strategies were both high importa nce and high feasibility, 4 were high importance and low feasibility, 1 wa s low importance and high feasibility, and 4 were low importance and low f easibility. Additionally, most high importance and high feasibility sustai nability strategies were mapped to the organization work system component. \n\nDiscussion:\nOrganization-centered strategies tended to be viewed as h igher importance and higher feasibility than strategies targeting other wo rk system components. Consensus was established in mostly high importance, high feasibility sustainability strategies, lower importance and feasibil ity strategies tended to see more disagreement on importance or feasibilit y scores or both. Consensus strategies for sustainability that target the task and internal environment components of the SEIPS model were not ident ified in this study, but these gaps reflect the nature of the C3I program, and the individuals involved with the SWG (C3I Coordinating Center and Ex pert Advisory Panel, 2021; Carayon et al., 2006). Future work will explore patient-generated strategies and the application of these strategies to s imilar programs planning for sustainability.\n\n\n\nReferences:\nC3I Coord inating Center and Expert Advisory Panel. (2021). Introduction to the Canc er Center Cessation Initiative Working Groups: Improving Oncology Care and Outcomes by Including Tobacco Treatment. Journal of the National Comprehe nsive Cancer Network, 19(Suppl_1), S1–S3. https://doi.org/10.6004/jnccn.20 21.7095\nCarayon, P., Hundt, A. S., Karsh, B., Gurses, A. P., Alvarado, C. J., Smith, M., & Brennan, P. F. (2006). Work system design for patient sa fety: The SEIPS model. Quality & Safety in Health Care, 15(Suppl 1), i50–i 58. https://doi.org/10.1136/qshc.2005.015842\nCroyle, R., Morgan, G., & Fi ore, M. (2019). Addressing a Core Gap in Cancer Care: The NCI Cancer Moons hotSM Initiative to Help Oncology Patients Stop Smoking. The New England J ournal of Medicine, 380(6), 512–515. https://doi.org/10.1056/NEJMp1813913\ nHolden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., O zok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors f ramework for studying and improving the work of healthcare professionals a nd patients. Ergonomics, 56(11). https://doi.org/10.1080/00140139.2013.838 643\nIslami, F., Goding Sauer, A., Miller, K. D., Siegel, R. L., Fedewa, S . A., Jacobs, E. J., McCullough, M. L., Patel, A. V., Ma, J., Soerjomatara m, I., Flanders, W. D., Brawley, O. W., Gapstur, S. M., & Jemal, A. (2018) . Proportion and number of cancer cases and deaths attributable to potenti ally modifiable risk factors in the United States. CA: A Cancer Journal fo r Clinicians, 68(1), 31–54. https://doi.org/10.3322/caac.21440\nWang, Y., Tao, H., Paxton, R. J., Wang, J., Mubarik, S., Jia, Y., Wang, W., & Yu, C. (2019). Post-diagnosis smoking and risk of cardiovascular, cancer, and al l-cause mortality in survivors of 10 adult cancers: A prospective cohort s tudy. American Journal of Cancer Research, 9(11), 2493–2514. END:VEVENT END:VCALENDAR