Implementing massage and acupuncture to achieve better pain management in oncology care (IMAGINE): protocol for an implementation project

Pain is a debilitating symptom that affects over 40% of patients with cancer in active treatment and up to two-thirds of patients with advanced cancer. Research indicates that acupuncture and massage therapy are associated with clinically important, sustained pain reduction and improved fatigue, insomnia, and quality of life. However, implementation of evidence-based protocols for acupuncture and massage for pain in people with cancer is limited. The Implementing Massage and Acupuncture To Achieve Better Pain Management in Oncology Care (IMAGINE) project aims to increase patient receipt of evidence-based oncology-specific acupuncture and massage therapy protocols using a multi-component implementation strategy. Thirty-five cancer centers were selected to participate as implementation sites. These sites are distributed across the country and include 22 National Cancer Institute (NCI) cancer centers and 13 non-NCI cancer centers located in 22 states. Each site created an implementation team that included: (1) the acupuncturists and massage therapists employed at each site, (2) a site lead who coordinates IMAGINE activities at the site, and (3) a physician or nurse champion who will advocate for the project with medical oncology providers. The 35 sites will be divided into four distinct cohorts that will proceed through the IMAGINE project in two phases: active implementation and maintenance. Three implementation strategies will be used: educational courses, educational materials, and external facilitation. The evaluation plan is informed by the RE-AIM framework with the primary outcome being the number of patients with cancer and pain who are treated with an acupuncture or massage protocol. We will also assess sites’ experiences with implementation barriers and facilitators and obtain feedback on successful long-term maintenance and scale-up using mixed methods with iterative evaluations. IMAGINE is the first large-scale, nation-wide implementation project in the field of integrative oncology. IMAGINE addresses three challenges in the field of integrative oncology: (1) lack of standardized delivery of high-quality therapies for pain in people with cancer; (2) limited knowledge of acupuncture/massage among oncology providers and patients; (3) frequent siloing of acupuncturists and massage therapists working in hospitals. Through this implementation, the IMAGINE project will elevate the practice standard for integrative oncology and improve patient outcomes.