Introduction Improving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative phase of our implementation-effectiveness trial, Self-Management and Activation to Reduce Treatment-Related Toxicities, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) and developed a process for mapping implementation strategies to local contexts.
Methods In this convergent mixed-method study, surveys and interviews were used to assess readiness and barriers/enablers for SMS among stakeholders in 3 disease site groups at 3 regional cancer centres (RCCs) in Ontario, Canada. Median survey responses were classified as a barrier, enabler or neutral based on a priori cut-off values. Barriers/enablers at each centre were mapped to CFIR and then inputted into the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC) to identify centre-specific implementation strategies. Qualitative data were separately analysed and themes mapped to CFIR constructs to provide a deeper understanding of barriers/enablers.
Results SMS in most of the RCCs was not systematically delivered, yet most stakeholders (n=78; respondent rate=50%) valued SMS. For centre 1, 7 barriers/12 enablers were identified, 14 barriers/9 enablers for centre 2 and 11 barriers/5 enablers for centre 3. Of the total 46 strategies identified, 30 (65%) were common across centres as core implementation strategies and 5 tailored implementation recommendations were identified for centres 1 and 3, and 4 for centre 2.
Conclusions The CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies.
- implementation science
- health services research
- ambulatory care
- chronic disease management
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Contributors Planning: DH, MP, RK, LM, MAO'B, MK. Conduct: DH, MP, RK, HA, LM, DB-L, MAO'B, SR, MK. Reporting: DH, MP, RK, HA, LM, DB-L, MAO'B, SR, MK. Overall content as guarantor(s): DH.
Funding Funding for this project was provided by the Canadian Institutes of Health Research’s (CIHR) Operating Grant (HRC 154129): Partnerships for Health System Improvement for Cancer Control, and in-kind contributions by Cancer Care Ontario.
Disclaimer The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsements by CIHR or Cancer Care Ontario is intended or should be inferred.
Competing interests HA and LM were employees of Cancer Care Ontario (CCO, now part of Ontario Health), who provided in-kind support for this study.
Patient consent for publication Not required.
Ethics approval The study has been approved through Clinical Trials Ontario (CTO), a centralised ethics review organisation for multicentre studies that is used by the three participating cancer centres. Approval number: 1371.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Aggregate data generated or analysed during this study are included in this published article (and its supplementary information files). Raw data generated or analysed during this study are available from the corresponding author on reasonable request.
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