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Implementation Mapping to Identify Strategies to Increase Timely Postoperative Radiotherapy Initiation for Head/Neck

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Timely postoperative radiotherapy (PORT) for head and neck cancers is crucial for survival. This study identified barriers and developed strategies, like clinician reminders, to improve PORT initiation rates in academic centers.

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PS/QIclinical qualityhead/neck cancerradiotherapy

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Area of Science:

  • Oncology
  • Implementation Science
  • Health Services Research

Background:

  • Timely initiation of postoperative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC) is linked to improved patient survival.
  • However, current rates of timely PORT initiation remain suboptimal in many clinical settings.

Purpose of the Study:

  • To identify implementation determinants (barriers and facilitators) impacting timely PORT initiation for HNSCC.
  • To design context-specific implementation strategies to enhance PORT uptake in a tertiary academic center.

Main Methods:

  • A sequential mixed-methods study was employed, utilizing surveys based on the Theoretical Domains Framework (TDF) to identify determinants.
  • Focus groups prioritized these determinants, and the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) matching tool was used to map barriers to strategies.
  • The Action, Actor, Context, Target, Time (AACTT) framework operationalized the selected strategies.

Main Results:

  • Twenty-three participants from Radiation Oncology, Otolaryngology, and Medical Oncology departments completed the survey.
  • Ten determinants affecting timely PORT initiation were identified.
  • Three evidence-based strategies—reminding clinicians, conducting educational meetings, and facilitating clinical data relay—were selected for implementation.

Conclusions:

  • A menu of actionable implementation strategies was developed to support timely PORT initiation for HNSCC.
  • The codesign approach, centering frontline healthcare workers' input, enhances the potential for successful strategy deployment.
  • The systematic methodology can serve as a model for process improvement in other healthcare contexts.