Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics

Frontiers in Health Services

Health Services

Tiffany H. Young¹  Sherry King²  Kendrel Cabarrus³  Mindy Gellin⁴  Neda Padilla⁴  Michelle Manning⁴  Allison M. Deal⁴  Lisa P. Spees⁵  Stephanie B. Wheeler⁵  Caitlin B. Biddell⁵  Arrianna Marie Planey⁵  Cleo A. Samuel-Ryals⁵  Donald L. Rosenstein⁶  Katherine Reeder-Hayes⁷  Brian Leutner⁸  Victoria M. Petermann⁹  Derek Vestal^1,10  Carla Strom^1,11  Ronny A. Bell^1,11  Sarah A. Birken^1,11 

[1] Buddy Kemp Support Center, Novant Health Cancer Institute, Charlotte, NC, United States;Carteret Health Care Cancer Center, Carteret, NC, United States;Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Pardee UNC Health Care, Hendersonville, NC, United States;School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;UNC Lenoir Health Care, Kinston, NC, United States;Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States;Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United States;

关键词: cancer;    financial toxicity;    financial navigation;    implementation science;    rural;    organizational readiness framework for advancing implementation science;   

DOI  :  10.3389/frhs.2023.1148887

 received in 2023-01-20, accepted in 2023-09-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundFinancial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations.MethodsWe conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality.ResultsResults from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources.ConclusionsStaff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices.

【 授权许可】

Unknown   
© 2023 Petermann, Biddell, Planey, Spees, Rosenstein, Manning, Gellin, Padilla, Samuel-Ryals, Birken, Reeder-Hayes, Deal, Cabarrus, Bell, Strom, Young, King, Leutner, Vestal and Wheeler.