Barriers encountered and implementation strategies deployed to facilitate real-world remote symptom monitoring in patients receiving active cancer treatment
Abstract
Background Remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) impacts patient and health system outcomes, yet data is lacking on real-world barriers to RSM and implementation strategies employed to address barriers. Methods Guided by the updated Consolidated Framework for Implementation Research 2.0 (CFIR), this two-site implementation evaluation of early RSM implementation and scale-up aimed to evaluate barriers, facilitators, and implementation strategies. Patients and clinical team members were interviewed. Transcripts were coded in NVivo using directed content analysis to categorize barriers and facilitators. The Longitudinal Implementation Strategy Tracking System (LISTS) method was used to track implementation strategies deployed. Incidences where a barrier was reported were linked to strategies employed, creating key barrier-strategy combinations. Kappa for agreement between coders (all >.80). Results 40 patients and 30 clinical team members (physicians, nurses, nurse practitioners, non-clinical navigators, administrators) completed interviews. Interviewees identified 47 barriers in the CFIR domains. Eight key barrier-strategy combinations were identified by both patients and clinic teams; 13 additional combinations were identified by both groups. Amongst these 21 barrier-strategy combinations, primary barriers addressed related to the innovation (19%), outer setting (10%), the inner setting (19%), individuals (10%), and implementation processes (43%). Unaddressed barriers persisted despite use of multiple implementation strategies. Conclusion Implementing RSM is complex and requires combinations of implementation strategies to overcome barriers at multiple CFIR levels. Future work is needed to leverage learnings from rigorous implementation studies to facilitate the RSM adoption. Trial registration NCT04809740, registered 3/18/2021