Project description:BackgroundIn clinical oncology practice, patient-reported outcomes (PROs) are essential for assessing the symptom burden, quality of life, and psychological status of patients. However, there remains a gap between the use of PROs in an oncologic setting and its implementation. Furthermore, numerous reviews in PRO implementation are often based on one particular technology, setting, or health condition, making it difficult to obtain a comprehensive and coherent summary of available evidence to help plan and undertake implementation. This systematic review aims to identify and integrate enablers and barriers to PRO implementation through the comprehensive framework for implementation research (CFIR) to provide a reference for implementing patient-reported outcomes management in oncology settings.MethodsThis review strictly observed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Web of Science, CINAHL, Embase, and PsycINFO databases were systematically searched using a three-step search strategy. The search was limited from the inception of each database to April 2024. Articles describing facilitators and barriers to implementing PROs in clinical oncology practice were included. Two researchers screened the literature independently, and the quality assessment of cross-sectional, qualitative, and mixed studies was completed using the critical appraisal tools recommended by Joanna Briggs Institute (JBI) and the mixed methods assessment tool, respectively. Basic information about the included studies and determinants affecting PRO implementation was extracted, and coding categorization of facilitators and barriers was completed based on the 48 constructs provided by the CFIR framework.ResultsWe included 30 studies from 5,649 search results, including 25 original and 5 review studies. The quality of the literature for qualitative studies was generally good, and the quality for quantitative and mixed studies was assessed as fair. We identified 52 facilitators and 50 barriers in the included literature, covering the domains used in the CFIR framework and 39 constructs, mainly including "Innovation Evidence-Base", "Innovation Complexity", "Innovation Design", "Structural Characteristics", "Compatibility", "Incentive Systems", "Access to Knowledge & Information", "Innovation Deliverers", "Innovation Recipients", and "Planning".ConclusionsThis systematic review integrated facilitators and barriers affecting PRO implementation in routine oncology clinical practice settings and categorized them through the CFIR framework. These influencing factors should be fully considered in future clinical practice to ensure the successful implementation of PROs.Trial registrationIt has been registered prospectively in PROSPERO under the registration number 42024532983.

Project description:BackgroundTranslation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic review identifies and explores relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions.MethodsWe searched MEDLINE, PsychInfo, Embase, Web of Science, and CINAHL using search terms focused specifically on barriers and facilitators to the implementation of patient-focused interventions in hospital settings. To be eligible, papers needed to have collected formal data (qualitative or quantitative) that specifically assessed the implementation process, as experienced by the staff involved.ResultsOf 4239 papers initially retrieved, 43 papers met inclusion criteria. Staff-identified barriers and facilitators to implementation were grouped into three main domains: system, staff, and intervention. Bi-directional associations were evident between these domains, with the strongest links evident between staff and intervention.ConclusionsResearchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success. The interrelationships between domains are also crucial, as resources in one area can be leveraged to address barriers in others. These findings emphasize the importance of careful intervention design and pre-implementation planning in response to the specific system and staff context in order to increase likelihood of effective and sustainable implementation.Trial registrationThis review was registered on the PROSPERO database: CRD42017057554 in February 2017.

Project description:BackgroundMultidisciplinary transitional care interventions aim to improve the coordination and continuity of healthcare during hospitalization and after discharge for patients with complex care needs related to physical, nutritional, or psychosocial status. Implementing such interventions is complex as they involve many stakeholders across multiple settings. Numerous studies have evaluated patients', family members', and healthcare professionals' experiences with multidisciplinary transitional care interventions, which can provide insight into facilitators and barriers to their implementation.ObjectiveTo provide an overview of facilitators and barriers to implementing multidisciplinary transitional care interventions, which could be considered before developing implementation strategies.DesignA qualitative systematic review using the Consolidated Framework for Implementation Research.SettingsHospitals and primary care.ParticipantsAdult patients admitted to a hospital, regardless of their diagnosis, as well as their family members and hospital and primary care healthcare professionals.MethodsEmbase, CINAHL, and Medline were searched for qualitative studies evaluating multidisciplinary transitional care interventions through patients', family members', and healthcare professionals' experiences and views from inception until June 2024. The methodological rigor was assessed with the Critical Appraisal Skills Program. We identified facilitators and barriers to the successful implementation of multidisciplinary transitional care interventions with the Consolidated Framework for Implementation Research. Facilitators and barriers were categorized into pre- or post-discharge or general factors.ResultsTwelve studies were included and appraised. We identified 79 factors, mostly linked to three domains of the Consolidated Framework for Implementation Research: Innovation, Inner setting, and Individuals involved. Facilitators included "comprehensive follow-up care needs assessment"(pre-discharge), "immediate, tailored follow-up care"(post-discharge), and "improved communication between stakeholders"(general). Barriers included "shortage of hospital beds" and "lack of time"(pre-discharge), "lack of available primary care professionals"(post-discharge), "inconsistencies of stakeholders' schedules" and "intervention costs"(general).ConclusionsThe factors identified could serve as a non-exhaustive inventory list to inspire readers who wish to implement a multidisciplinary transitional care intervention in their settings. Digital tools and alternative financing models might overcome cost and reimbursement issues, the increasing complexity of patient care, and shortcomings, such as the lack of available hospital beds or professionals. Further research should identify effective implementation strategies, considering the pre-, post-discharge, and general factors identified.RegistrationThe protocol was registered in PROSPERO (CRD42023421423).Tweetable abstractEffective communication aids in implementing transitional care interventions, but patient care complexity and healthcare system pressures present challenges.

Project description:BackgroundPersons living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, healthcare providers, and hypertensive PLHIV (n = 83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration.ResultsBarriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives and rewards, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy, and planning. The barriers include lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV's inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN, and inadequate planning for integrated HTN/HIV services.Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability, and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration.ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers, and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

Project description:BackgroundIndividuals in rural areas consistently demonstrate higher mortality and morbidity rates, and poorer access to healthcare, compared to their metropolitan counterparts. Optimizing the implementation of evidence-based interventions can reduce these inequities. Existing literature outlines numerous barriers and facilitators to the implementation of healthcare interventions, but these are generally not specific to rural areas. This rapid review aims to synthesize barriers and facilitators to the implementation of healthcare interventions in regional and rural healthcare services as reported by healthcare staff, including clinicians, managers, and administrators.MethodsA systematic search for peer-reviewed publications was conducted using CINAHL, PsycINFO, Medline, and Embase databases (1/1/2000-29/08/2023). Eligible publications were primary research articles published in English, assessing staff-reported barriers and facilitators to implementing healthcare interventions within regional and rural areas of high-income countries. Qualitative, quantitative, and mixed-methods designs were included. Eligible healthcare settings encompassed acute, sub-acute, primary care, community health, and aged care. Barrier and facilitator data were coded and grouped into sub-themes and broader themes, with results presented narratively.ResultsThirty-nine publications met the inclusion criteria. Most studies were conducted in Australia or the USA (both n = 18, 46%), within primary care (n = 13, 33%) or hospital settings (n = 12, 31%) in rural (n = 22, 56%) or regional (n = 9, 23%) locations. Implementation barriers and facilitators were grouped into four overarching themes: intervention-level (intervention feasibility and fit; complexity; privacy and confidentiality); staff-level (staff attitudes and beliefs; knowledge, skills, and confidence; staff roles and professional identity), patient-level (patient characteristics; attitudes), and system-level (leadership support; environmental resources and context; geographic vastness; networks and communication).ConclusionsThese findings provide essential guidance for policymakers, healthcare leaders, and researchers in planning and designing future implementation efforts in regional and rural healthcare settings. By considering factors across intervention, staff, patient, and system levels, stakeholders can address challenges and leverage local strengths to enhance implementation success and reduce health disparities.Trial registrationPROSPERO registration number: CRD42023470736. Registered 19/10/2023.

Project description:BackgroundAs one of the most cost-effective investments for improving child nutrition, micronutrient powder (MNP) has been widely used in many countries to underpin the Sustainable Development Goals, yet challenges remain regarding its implementation on a large scale. However, few studies have explored the factors that facilitate or impede the implementation process using implementation science theories and frameworks. To address this gap, we adopted the Consolidated Framework of Implementation Research (CFIR) and conducted a systematic review of studies on the implementation barriers to and facilitators of MNP interventions.MethodFive publication databases, including EMBASE, Medline, PubMed, Web of Science, and Scopus, were searched for studies on the influencing factors of MNP interventions. Based on the CFIR framework, the facilitators and barriers for the MNP program implementation reported in the included studies were extracted and synthesized by five domains: intervention characteristics, outer setting, inner setting, individual characteristics, and process.ResultsA total of 50 articles were eligible for synthesis. The majority of the studies were conducted in lower-middle-income countries (52%) through the free delivery model (78%). The inner setting construct was the most prominently reported factor influencing implementation, specifically including available resources (e.g., irregular or insufficient MNP supply), structural characteristics (e.g., public-driven community-based approach), and access to information and knowledge (e.g., lack of training for primary-level workers). The facilitators of the engagement of private sectors, external guidelines, and regular program monitoring were also highlighted. On the contrary, monotonous tastes and occasional side effects impede intervention implementation. Additionally, we found that the inner setting had an interrelation with other contributing factors in the MNP program implementation.ConclusionOur results suggest that MNP program implementation was prominently influenced by the available resources, organizational structure, and knowledge of both providers and users. Mobilizing local MNP suppliers, engaging public-driven free models in conjunction with market-based channels, and strengthening the training for primary-level health workers could facilitate MNP interventions.

Project description:IntroductionAssertive Community Treatment (ACT), which was developed in the 1970s in the USA, is a programme that supports people with severe mental illness living in the community through a multidisciplinary team, individual care and outreach approach. It is widely known that ACT effectively decreases hospital stays and improves Global Assessment of Functioning scores. In Japan, empirical studies on ACT were conducted in the late 2000s. Through the introduction of the standardised programme and domestic network, its implementation nationwide was anticipated. However, to date, the implementation of ACT is limited. There has been no comprehensive research in Japan on what inhibits and promotes the implementation of ACT in community mental health settings. Therefore, in this study, we aimed to systematically and comprehensively investigate the factors influencing the implementation of ACT in Japan using implementation research.Methods and analysisA qualitative study will be conducted using semistructured interviews with key stakeholders in the ACT team. Interviews will be conducted face-to-face or online, using an interview guide. The inclusion criteria are present and past ACT teams. Recruitment will be in two steps. A preinterview questionnaire will be sent to the members of the Community Mental Health Outreach Association regarding their basic characteristics and fidelity to the ACT model, and purposive sampling will be performed based on it. The Consolidated Framework for Implementation Research will be used to collect and analyse the interview data according to the qualitative content analysis, with reference to the fidelity category, because this will help to find influencing factors by identifying constructs that appear to distinguish between high-fidelity and low-fidelity teams.Ethics and disseminationThis study has been approved by the Tokyo Medical University Ethics Approval Committee (approval number: T2022-0175). The findings will be shared via peer-reviewed journal publications and presentations to policymakers and service users.

Project description:BackgroundOver the last decade, paediatric palliative care teams (PPCTs) have been introduced to support children with life-limiting diseases and their families and to ensure continuity, coordination and quality of paediatric palliative care (PPC). However, implementing a PPCT into an organisation is a challenge. The objective of this study was to identify barriers and facilitators reported by healthcare professionals (HCPs) in primary, secondary or tertiary care for implementing a newly initiated multidisciplinary PPCT to bridge the gap between hospital and home.MethodsThe Measurement Instrument for Determinants of Innovations (MIDI) was used to assess responses of 71 HCPs providing PPC to one or more of the 129 children included in a pilot study of a PPCT based at a university children's hospital. The MIDI (29 items) assessed barriers and facilitators to implementing the PPCT by using a 5-point scale (completely disagree to completely agree) and additional open-ended questions. Items to which ≥20% of participants responded with 'totally disagree/disagree' and ≥80% responded with 'agree/totally agree' were considered as barriers and facilitators, respectively. A general inductive approach was used for open-ended questions.ResultsReported barriers to implementing a PPCT were related to the HCP's own organisation (e.g., no working arrangements related to use of the intervention [PPCT] registered, other organisational changes such as merger going on). Reported facilitators were mainly related to the intervention (correctness, simplicity, observability and relevancy) and the user scale (positive outcome expectations, patient satisfaction) and only once to the organisation scale (information accessibility). Additionally, HCPs expressed the need for clarity about tasks of the PPCT and reported having made a transition from feeling threatened by the PPCT to satisfaction about the PPCT.ConclusionPositive experiences with the PPCT are a major facilitator for implementing a PPCT. Tailored organisational strategies such as working arrangements by management, concrete information about the PPCT itself and the type of support provided by the PPCT should be clearly communicated to involved HCPs to increase awareness about benefits of the PPCT and ensure a successful implementation. New PPCTs need protection and resources in their initial year to develop into experienced and qualified PPCTs.

Project description:BackgroundThe COVID-19 pandemic produced unprecedented demands and rapidly changing evidence and practices within critical care settings. The purpose of this study was to identify factors and strategies that hindered and facilitated effective implementation of new critical care practices and policies in response to the pandemic.MethodsWe used a cross-sectional, qualitative study design to conduct semi-structured in-depth interviews with critical care leaders across the United States. The interviews were audio-taped and professionally transcribed verbatim. Guided by the Consolidated Framework for Implementation Research (CFIR), three qualitative researchers used rapid analysis methods to develop relevant codes and identify salient themes.ResultsAmong the 17 hospitals that agreed to participate in this study, 31 clinical leaders were interviewed. The CFIR-driven rapid analysis of the interview transcripts generated 12 major themes, which included six implementation facilitators (i.e., factors that promoted the implementation of new critical care practices) and six implementation barriers (i.e., factors that hindered the implementation of new critical care practices). These themes spanned the five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Process) and 11 distinct CFIR constructs. Salient facilitators to implementation efforts included staff resilience, commitment, and innovation, which were supported through collaborative feedback and decision-making mechanisms between leadership and frontline staff. Major identified barriers included lack of access to reliable and transferable information, available resources, uncollaborative leadership and communication styles.ConclusionsThrough applying the CFIR to organize and synthesize our qualitative data, this study revealed important insights into implementation determinants that influenced the uptake of new critical care practices during COVID-19. As the pandemic continues to burden critical care units, clinical leaders should consider emulating the effective change management strategies identified. The cultivation of streamlined, engaging, and collaborative leadership and communication mechanisms not only supported implementation of new care practices across sites, but it also helped reduce salient implementation barriers, particularly resource and staffing shortages. Future critical care implementation studies should seek to capitalize on identified facilitators and reduce barriers.

Dataset Information

Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research

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