Team-Based Versus Technology-Based Supportive Cancer Care: A Mixed Methods Study of Multi-Site Implementation

Supportive cancer care (SCC), defined as advance care planning and symptom management, is nationally recommended for people with cancer. However, barriers persist in its delivery. To address these barriers, we launched a cluster-randomized, multisite clinical trial to evaluate team-based SCC approaches led by lay health educators versus technology-based delivery of SCC education. This mixed methods study aimed to identify implementation barriers and facilitators impacting comparative effectiveness, implementation, adoption, and sustainability of these approaches.

Study staff at 26 cancer clinics participated in a 45-minute semistructured interview and a 71-question survey developed using the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We employed a convergent parallel mixed methods analysis approach: interviews were qualitatively coded and analyzed using content analysis methods, and surveys were analyzed using descriptive statistics. Synthesized interview findings were merged with survey findings for final interpretation.

Participants unanimously agreed that SCC is essential for patients with cancer. All highlighted infrastructural and cultural barriers to implementation, including funding constraints, limited organizational prioritization, stigma related to advance care planning, and varying needs of diverse patient populations. There was broad support for team-based approaches and shared concern that technology-based approaches implemented alone could worsen cancer disparities. The impact of these approaches on total costs of care was emphasized as an important outcome, given that such data could potentially convince payer organizations to reimburse for these supportive care services.

Findings from this study reveal significant infrastructural, organizational, and policy factors influencing adaptability and sustainability of SCC in practice. Such findings may influence the comparative effectiveness of the SCC approaches in the ongoing, multisite cluster randomized trial.