Portfolio analysis of NCI-funded implementation science grants studying sustainability of cancer control evidence-based practices

Abstract

Abstract Background Sustainability is a key focus in implementation science given the global challenge of ensuring evidence-based practices (EBPs) deliver long-term benefits across community, public health, and clinical settings. We conducted a portfolio analysis of NCI-funded implementation science grants to describe the characteristics of funded applications that proposed to study the sustainability of cancer control EBPs and identify opportunities to advance the field. Methods A systematic search using the National Institutes of Health (NIH) Query View Report tool identified NCI-funded implementation science grants with sustainability-focused aims awarded between fiscal years 2017 and 2023. Two coders independently reviewed full grant application materials to determine eligibility and extract information using a structured codebook developed, pilot-tested, and iteratively revised prior to full coding. Variables captured study objectives, proposed designs, sustainability measurement approaches, outcomes, implementation strategies, how sustainability was defined, and theories, models, or frameworks proposed. Results Of 351 implementation science grants identified through the search strategy, 72 included at least one sustainability-focused aim and were included in the analysis. Most funded applications ( n = 58, 81%) were awarded between 2020 and 2023. Only 4 proposed sustainability as the focus of all study aims. The majority examined sustainability determinants ( n = 55, 76.4%), and only one proposed to evaluate the impact of an implementation strategy on sustainability. Funded applications focused primarily on cancer prevention ( n = 54, 75%) and screening ( n = 33, 45.8%). More than half ( n = 39, 54.2%) did not provide an explicit definition for sustainability-related terms, and many used sustainability, maintenance, and sustainment interchangeably. Of the 72 funded applications, 64 (88.9%) used at least one theory, model, or framework, and 32 (44.4%) used two or more in combination. Conclusions Our findings highlight opportunities to advance sustainability research across several areas, including the operationalization of sustainability concepts at the grant design stage, use of sustainability-specific frameworks and measurement tools, evaluation of implementation strategies designed to support sustainability of EBPs, and documentation of sustainability-relevant adaptations across diverse organizational, community, and health system contexts. Addressing these gaps can help to build a stronger evidence base for the sustainability of cancer control EBPs in the United States and globally.