Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC.
JCO Oncol Pract. 2022 Sep;18(9):e1513-e1521. doi: 10.1200/OP.22.00063. Epub 2022 Jun 24.
The nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer in the United States yearly have tended to occupy a no-man's land between medical and pediatric oncology, often reporting that existing models of care are misaligned with their needs and preferences. Although guidelines for optimal AYA cancer care are increasingly available, the implementation of such standards has been varied. This may be in part due to a lack of guidance for implementing specialized AYA care. In this study, we leveraged an implementation science framework to identify barriers and generate practical guidance to inform the implementation of specialized AYA cancer care.
We conducted semistructured qualitative interviews, guided by the Consolidated Framework for Implementation Research, with AYA care stakeholders (N = 32 from 14 cancer programs). Our multidisciplinary research team analyzed interview transcriptions using a template analysis approach and gleaned from interviews practical guidance for implementing specialized AYA care.
Participants reported barriers to implementing specialized AYA care across all five Consolidated Framework for Implementation Research domains: (1) intervention characteristics (eg, costs), (2) inner setting (eg, difficulties in collaborating between pediatric and medical oncology), (3) outer setting (eg, patient-level barriers to participating in AYA services), (4) individual characteristics (eg, attitudes about AYA oncology), and (5) process (eg, lack of metrics for program evaluation). They also shared practical guidance for addressing these barriers.
Emerging guidance on the core elements of AYA cancer care must be matched with guidance to support the implementation of specialized AYA care. This study contributes to the body of evidence available to inform future implementation efforts.
美国每年约有 9 万名青少年和年轻人（AYA）被诊断患有癌症，他们往往处于医学肿瘤学和儿科肿瘤学之间的无人区，他们经常报告说现有的护理模式不符合他们的需求和偏好。尽管越来越多的指南提供了优化 AYA 癌症护理的建议，但这些标准的实施情况却各不相同。这可能部分是由于缺乏实施专门 AYA 护理的指导。在这项研究中，我们利用实施科学框架来确定障碍，并提供实用的指导，为实施专门的 AYA 癌症护理提供信息。
我们对 AYA 护理利益相关者（来自 14 个癌症项目的 32 人）进行了半结构化定性访谈，这些访谈是由实施科学研究整合框架指导的。我们的多学科研究团队使用模板分析方法对访谈记录进行了分析，并从访谈中获取了实施专门的 AYA 癌症护理的实用指导。
参与者报告了在所有五个实施科学研究整合框架领域实施专门的 AYA 护理的障碍：（1）干预措施的特点（如成本），（2）内在环境（如儿科肿瘤学和医学肿瘤学之间合作的困难），（3）外在环境（如患者参加 AYA 服务的障碍），（4）个体特征（如对 AYA 肿瘤学的态度）和（5）过程（如缺乏衡量项目评估的指标）。他们还分享了针对这些障碍的实用指导。
必须将有关 AYA 癌症护理核心要素的新兴指导与支持专门 AYA 护理实施的指导相结合。本研究为未来的实施工作提供了有价值的证据。
