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Why and When Are Evidence-Based Interventions Adopted in Paediatric Supportive Care? A Qualitative Exploration of the
Claudia Heggie1, Kara A Gray-Burrows2, Peter F Day3
1Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
Insights
Implementing photobiomodulation for oral mucositis in children undergoing cancer treatment requires addressing local service factors, not just clinical evidence. Optimizing care delivery involves aligning services, workforce, and networks for equitable access.
Area of Science:
- Oncology
- Supportive Care
- Implementation Science
Background:
- Oral mucositis is a frequent, severe side effect of cancer treatments in children and young people (CYP).
- Photobiomodulation is recommended for prevention but has low implementation rates in UK treatment centers.
- This impacts CYP quality of life and strains healthcare services.
Purpose of the Study:
- To explore barriers and facilitators to implementing photobiomodulation in standard pediatric cancer care.
- To identify factors influencing the adoption of photobiomodulation for oral mucositis prevention.
- To inform strategies for equitable integration of evidence-based interventions.
Main Methods:
- Purposive sampling of CYP, parents, and healthcare professionals (HCPs) across diverse treatment centers.
- Semi-structured interviews analyzed using deductive framework analysis (Consolidated Framework for Implementation Research) and inductive thematic analysis.
- Patient involvement groups refined overarching themes.
Main Results:
- Interviews with 27 participants (18 HCPs, 1 industry rep, 4 CYP/Parent dyads) revealed varied barriers and facilitators.
- Key themes included: framing photobiomodulation as essential, its perceived simplicity, need for multiprofessional networks, balancing standardization with individualization, and increasing LED system adoption.
- Experience with low-level laser and LED systems was documented.
Conclusions:
- Successful photobiomodulation implementation hinges on local conditions and service integration, not solely clinical evidence.
- Aligning service structures, workforce capacity, and professional networks is crucial for embedding photobiomodulation.
- Theory-informed strategies can reduce inequities and serve as a model for other supportive care interventions.
Background:
Oral mucositis is a common and debilitating side effect of childhood cancer and stem cell transplant treatments. It affects the quality of life of children and young people (CYP) and places a strain on services. Photobiomodulation is recommended for oral mucositis prevention in international guidance but is poorly implemented in UK Principal Treatment Centres (PTCs). Our study explored the key barriers and facilitators to implementing photobiomodulation into standard care.
Methods:
CYP, their parents, and healthcare professionals (HCPs) were purposively sampled for diversity in theoretically important characteristics: stage of adoption of PTC, professional role (HCPs), age (CYP), and photobiomodulation modality. Initial deductive framework analysis on semi-structured interview data was guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative summaries were then inductively generated, articulating the valence of influence and effect. Overarching themes were developed and refined in collaboration with patient involvement groups.
Results:
Twenty-seven participants were interviewed: 18 HCPs from 11 diverse PTCs, 1 industry representative, and 4 CYP/Parent dyads. Participants had experience with low-level laser (n = 15) and light-emitting diode (LED) (n = 13) systems. Perceived barriers and facilitators varied between PTCs, participant groups, and photobiomodulation systems. Five themes were developed: (1) framing photobiomodulation as essential to routine care in busy cancer services; (2) photobiomodulation as simple, proactive, and rewarding; (3) need for navigable, interconnected, multiprofessional networks to support implementation; (4) balancing individualisation of services with the need for guidance and standardisation; and (5) increasing implementation of LED systems, with fewer barriers, over time.
Conclusion:
Implementing photobiomodulation in paediatric oncology depends less on its clinical evidence and more on the local conditions that enable reliable delivery. This study highlights the importance of aligning service structures, workforce capacity, and professional networks to 'embed' photobiomodulation as routine care. Theory-informed implementation strategies can reduce current inequities in access and provide a transferable model for introducing other evidence-based supportive care interventions.
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