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Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies

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Abstract

Background

Cancer rehabilitation navigation (CRNav) is a care delivery model that expedites identification and management of symptom-related functional morbidity for individuals undergoing cancer treatment. A CRNav program is unique in that it embeds a cancer rehabilitation professional in the cancer center for patient screening and assessment. The implementation of CRNav programs has not been studied and doing so could facilitate greater uptake of these programs.

Methods

Using implementation science frameworks, we conducted a qualitative, post-implementation analysis of a CRNav program that was implemented in 2019. Semi-structured, 1:1 interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and a combination of deductive and inductive analyses, using a priori established codes, was used to assess the implementation context, and identify emergent themes of barriers and facilitators to implementation. Participant described implementation strategies were characterized and defined using the Expert Consensus Recommendations for Implementing Change (ERIC) taxonomy.

Results

Eleven stakeholders including physicians, administrators, clinical staff, and patients, involved with program development and the implementation effort, participated in interviews. Predominant barriers to implementation included develo** the program infrastructure, and lack of awareness of rehabilitation services among oncology professionals, predominant facilitators of implementation included; physical co-location of the navigator in the cancer center, individual characteristics of the navigator, and unique characteristics of the program. Strategies described that supported implementation included develo** stakeholder interrelationships, evaluating and iteratively adapting the program, creating infrastructure, training and education, and supporting clinicians.

Conclusion

This analysis uses implementation science to methodically analyze and characterize factors that may contribute to successful implementation of a CRNav program. These findings could be used alongside a prospective context-specific analysis to tailor future implementation efforts.

Implications for Cancer Survivors

Implementing a CRNav program expedites a patient’s direct contact with a rehabilitation provider complementing the cancer care delivery team, and providing an additive and often missing service.

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Data availability

N/A.

Notes

  1. USC IRB Approval Number: 00115153.

  2. https://cfirguide.org/

  3. https://zoom.us/.

  4. https://www.temi.com/.

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Funding

This work was funded by the APTA Academy of Oncologic Physical Therapy Research Grant 2021.

Author information

Authors and Affiliations

  1. School of Medicine, Department of Hematology/Oncology, Cancer Prevention and Control, West Virginia University, Morgantown, WV, USA

    Nicole L. Stout

  2. School of Public Health, Department of Health Policy, Management, and Leadership, West Virginia University, Morgantown, WV, 26506, USA

    Nicole L. Stout

  3. Arnold School of Public Health, Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, SC, USA

    Shana E. Harrington

  4. Halifax Health | Brooks Rehabilitation, Daytona, FL, USA

    Ashley Perry

  5. Department of Physical Therapy, University of Florida, Gainesville, FL, USA

    Meryl J. Alappattu

  6. School of Medicine, Human Performance, School of Physical Therapy, West Virginia University, Morgantown, WV, USA

    Victoria Pfab & Benjamin Stewart

  7. Brooks Rehabilitation, Jacksonville, FL, USA

    Meryl J. Alappattu & Mindi R. Manes

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Contributions

Concept development—NS, SH, AP, MA.

Data collection—NS, VP, BS, AP.

Data analysis—NS, VP, BS, AP.

Manuscript writing—NS, SH, VP.

Figure preparation- NS.

Manuscript review and approval- all authors.

Corresponding author

Correspondence to Nicole L. Stout.

Ethics declarations

Ethics approval

University of South Carolina IRB approval: 00115153, West Virginia University IRB: 2202514439.

Consent for publication

All authors have reviewed the final manuscript and consent to publication.

Competing interests

Stout- Survivorship solutions LLC, Medbridge Inc.

Harrington, Perry, Alappattu, Pfab, Stewart, Manes—none.

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Stout, N.L., Harrington, S.E., Perry, A. et al. Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01374-5

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