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

Area of Science:

• Oncology
• Health Services Research
• Implementation Science

Background:

• Supportive cancer care (SCC), encompassing advance care planning and symptom management, is a national recommendation for cancer patients.
• Persistent barriers hinder the effective delivery of SCC, necessitating innovative implementation strategies.
• A multisite clinical trial was initiated to compare team-based SCC led by lay health educators with technology-based SCC education delivery.

Purpose of the Study:

• To identify implementation barriers and facilitators for different SCC delivery models.
• To evaluate the comparative effectiveness, implementation, adoption, and sustainability of team-based versus technology-based SCC approaches.
• To understand the impact of SCC on total costs of care for potential payer reimbursement.

Main Methods:

• A convergent parallel mixed methods approach was used, combining semistructured interviews and surveys with study staff at 26 cancer clinics.
• Qualitative data from interviews were analyzed using content analysis, while survey data were analyzed using descriptive statistics.
• The Consolidated Framework for Implementation Research (CFIR) and RE-AIM framework guided study design and analysis.

Main Results:

• Participants universally recognized the essential nature of SCC for cancer patients.
• Infrastructural and cultural barriers, including funding, prioritization, stigma, and diverse patient needs, were identified.
• While team-based SCC received broad support, concerns were raised that technology-based approaches alone could exacerbate cancer disparities.

Conclusions:

• Significant infrastructural, organizational, and policy factors critically influence the adaptability and sustainability of SCC in clinical practice.
• These factors are likely to impact the comparative effectiveness of the evaluated SCC approaches in the ongoing trial.
• Addressing identified barriers is crucial for successful implementation and long-term sustainability of supportive cancer care services.