Prioritization and multilevel mapping of implementation strategies for a cancer rehabilitation navigation program

Although determinants and strategies for implementing a cancer rehabilitation navigation (CRNav) program have been described, defining specific implementation interventions could improve uptake in oncology care delivery. This manuscript shares prioritized implementation interventions using a multilevel framework.

We convened interdisciplinary stakeholders from two CRNav programs to participate in an implementation mapping focus group. Using a multilevel framework that considered provider-, clinic-, and system-level interventions, the focus group discussion guide sought participant input on specific interventions that needed to occur at each level to facilitate implementation. The focus group transcript was analyzed using deductive thematic coding to identify program implementation interventions at each level. The interventions were then shared with all stakeholders to seek agreement and prioritization using a modified Delphi process. A priori a 70% threshold was established to define agreement. Two rounds of Delphi were conducted.

Fifteen stakeholders were recruited and nine participated in the focus group. The implementation mapping exercise identified 19 different interventions within the following Expert Recommendations for Implementing Change domains by level: provider level-use evaluative and iterative strategies, provide interactive assistance, train and educate stakeholders, support clinicians; clinic level-change infrastructure, support clinicians, adapt and tailor to context, use evaluative and iterative strategies; and system level-develop stakeholder interrelationship, use financial strategies, change infrastructure. Seven of 15 individuals completed both rounds of the Delphi. Fourteen interventions achieved agreement for high importance. Highest prioritized implementation interventions were develop a core champion team, develop a rationale for program justification, agree upon outcomes measures for the program, and examine and contextualize barriers that will influence the program.

Clinical implementation of an innovative care delivery model requires attention to specific interventions that affect various levels within a health care system. These findings will inform future research and clinical efforts in the implementation of CRNav programs.