Nickola is a HRB SPHeRE (Structured Population and Health Services Research Education) PhD scholar at the School of Public Health, University College Cork. Her PhD is focusing on developing an implementation intervention to improve the quality and reach of self-management support in cancer care. Her research interests include cancer survivorship, quality improvement and implementation science. Prior to her PhD she was a lecturer in Therapeutic Radiography in London Southbank University, and a Cancer Research UK pre-doctoral fellow in the Department of Behavioural Science and Health in University College London.
Self-management support (SMS) is a key component of quality cancer survivorship delivery. However, implementation is a problem internationally. In response to national policy an evidence-based SMS programme ‘Cancer Thriving and Surviving’ (CTS) has been rolled out in Ireland. However, implementation is not uniform across contexts. We report the main barriers, facilitators, and contextual factors relevant to implementing SMS across cancer organisations in Ireland.
The Consolidated Framework for Implementation Research (CFIR) informed the topic guide and analysis. Transcripts were analysed inductively by the interview guide and the research questions. Categories were then coded deductively to the CFIR constructs. Analysis of the interviews were further sensitised by Normalisation Process Theory to help uncover why determinants may influence implementation.
Interviews were conducted with 47 stakeholders (nurses, physiotherapists, occupational therapists, dietitians, oncologists, psychologists, psychiatrists, social workers, and programme deliverers living with and beyond cancer) from 19 organisations. Findings highlight that when stakeholders believe in the benefit of CTS on patient outcomes and when these outcomes are aligned with personal and organisational goals implementation becomes a priority. When aligned with organisational goals leadership had stronger buy-in and secured resources to enable implementation. The need for policy support; regulatory and professional guidelines highlighting CTS for implementation may secure buy in. Enablers included a positive organisational culture of deliverer-centeredness, with performance feedback and incentives. As well as collaboration among stakeholders, characterised by close working relationships and communication processes across and within organisations.
These findings highlight theoretically based factors that influence implementation of SMS, which can be used to inform tailoring of implementation strategies. Strategies that improve awareness regarding the positive impact of SMS, align SMS with organisational goals, secure buy-in and support a culture of delivered centeredness and collaboration may be needed to implement SMS.