PROJECT SUMMARY The population of older and medically complex cancer patients is growing exponentially, calling for the involvement of primary care providers (PCPs) in team-based models to deliver high-quality care to cancer patients across the continuum. Team-based care is especially needed in light of the rapid growth in diagnoses of low-risk cancers (such as prostate, thyroid, and breast). Not only are these patients typically older and with more comorbidities, but treatment strategies are increasingly moving away from surgery and radiation to active surveillance. Because guidelines for low-risk prostate cancer now recommend active surveillance as the primary disease management strategy, it represents the ideal case for studying how to better engage PCPs. A key gap where PCP involvement can help is in improving adherence to active surveillance; though a growing number of men are choosing this strategy, adherence to active surveillance once chosen remains suboptimal. Thus, it is critical to understand how to support men with low-risk prostate cancer to maximize adherence to active surveillance and importantly, how to effectively engage PCPs in low-risk cancer management. Dr. Radhakrishnan’s long-term career goal is to become an independent clinician-investigator focused on optimizing the role of PCPs in team-based care delivery across the cancer continuum. She is focusing on low- risk cancer management given the timely and critical need to meet the demands of the growing number of low- risk cancer patients. Leveraging the Michigan Urological Surgery Improvement Collaborative (MUSIC), this project aims to: 1) characterize provider and patient perspectives on active surveillance adherence; 2) design a patient-centered intervention that enables providers to support men on active surveillance to maximize adherence; and 3) perform a pilot evaluation of the intervention on key outcomes at primary care and urology practices. Successful completion of this work, and subsequent R01 studies, will improve low-risk cancer management by developing a patient-centered intervention integrated into primary care delivery systems. Dr. Radhakrishnan seeks to build upon her clinical background as a PCP and her research fellowship training to acquire additional skills and experiences to achieve her long-term career goal. With her mentoring team, she has developed a comprehensive career development plan that will support her to: 1) accomplish her training aims and develop a strong skillset in qualitative methods and expertise in intervention design, evaluation, and implementation; and 2) engage in career development activities to enable her to transition to independence as a clinician-investigator. She will be supported by a multidisciplinary team of dedicated mentors and advisors, who will oversee a broad range of coursework and experiential learning, and are committed to ensuring her success. Additionally, the University of Michigan offers Dr. Radhakrishnan the ideal environment for this proposal, with its exceptional resources and an outstanding mentoring team with proven success in developing junior clinician-scientists.

PROJECT NARRATIVE In light of increasingly older and medically complex cancer patients, national organizations are calling for team- based care delivery, where primary care providers (PCPs) help cancer specialists provide coordinated care across the cancer continuum. Low-risk prostate cancer serves as an ideal case study to explore increasing PCP involvement; adherence to active surveillance as a treatment strategy is sub-optimal, yet how to support men to maximize their adherence is poorly understood. This project will generate new knowledge on how to maximize adherence to active surveillance for men with low-risk prostate cancer, and importantly, how to effectively engage PCPs in low-risk cancer management.