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Published on: April 11, 2016
Facilitators and Barriers for Implementing Diagnostic Sequencing Technology for Pediatric Oncology in Low- and
Kenneth M Busby1,2, Nathaniel Webb3, Javeria Aijaz4
1Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA.
Background:
Inaccurate or imprecise diagnosis is a major contributor to treatment failure for children with cancer in low- and middle-income countries (LMICs). Sequencing-based diagnostic testing presents an opportunity to overcome diagnostic deficiencies. It is important to identify facilitators and barriers which are common to the implementation of sequencing-based diagnostics in LMICs.
Procedure:
Pediatric oncology research collaborators at six hospitals in LMICs were invited to participate in the study. Snowball sampling identified additional participants. Thirty-nine virtual, semi-structured interviews were conducted using interview guides informed by the Consolidated Framework for Implementation Research (CFIR) with suggested adaptations for LMICs. Rapid qualitative analysis was conducted to identify facilitators and barriers to the implementation of diagnostic sequencing for pediatric cancers. Barriers were then matched with expert recommendation for implementation change (ERIC) strategies.
Results:
Implementation facilitators and barriers were organized by CFIR construct. Predominant facilitators were relative advantage, culture, collective efficacy, self-efficacy, patient needs and resources, leadership engagement, knowledge and beliefs, tension for change, monitoring services for action, and implementation climate. Key barriers to implementation were cost, available resources, resource continuity, engaging participants, and resource source.
Conclusions:
Participants communicated that the lack of diagnostic classification for pediatric cancer in LMICs is a common key limitation to current cancer care. They described considerable motivating strengths to leverage toward this goal of developing sequencing-based diagnostic testing capacity. Resource availability, continuity, and sustainability are current barriers that must be addressed. Our data highlight the urgent need for creative global implementation partnerships as many centers in LMICs are poised to advance novel diagnostic solutions.
