Preimplementation expectations and perceptions of a preoperative frailty screening and optimization intervention: A...

Area of Science:

• Geriatric Surgery
• Implementation Science
• Health Services Research

Background:

• Frailty increases postoperative mortality and adverse outcomes.
• Limited evidence exists for interventions to mitigate frailty-related surgical risks.
• The PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery (FOCUS) trial investigates frailty screening and multidisciplinary optimization.

Purpose of the Study:

• Identify systemic and individual factors influencing the implementation of the FOCUS trial intervention.
• Tailor the intervention to local contexts to improve implementation success.
• Summarize findings from a preimplementation formative evaluation of the FOCUS trial.

Main Methods:

• Utilized the Consolidated Framework of Implementation Research (CFIR) for trial implementation and analysis.
• Conducted qualitative analysis through individual interviews and focus groups with stakeholders at 3 Veterans Affairs medical centers.
• Employed team-based thematic analysis with dual coding review (Krippendorf α = .92).

Main Results:

• Innovation, setting, and implementation were the most relevant CFIR domains identified.
• Stakeholders recognized the value of the multidisciplinary approach and potential benefits of the frailty intervention.
• Barriers included concerns about relative advantage, workflow compatibility, staffing, and resources, with context-specific recommendations provided.

Conclusions:

• Provider support for the FOCUS intervention was evident, but local logistical and site/specialty-specific factors pose implementation challenges.
• Preimplementation formative evaluation is crucial for identifying and addressing barriers in complex clinical trial designs.
• Adaptations informed by formative evaluation can enhance the uptake of multidisciplinary frailty optimization interventions.