Gharzai Laila A, Bromfield Jaymie, Kwan Michelle, Larson Alexis, Kingsbury Janine A, Akthar Adil, Agarwal Gaurava, Vermylen Julia H, Becker Sara, Scott Kelli, Van Pelt Amelia E, Stepan Katelyn O
Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA.
Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA.
Otolaryngol Head Neck Surg. 2025 Jul;173(1):288-298. doi: 10.1002/ohn.1268. Epub 2025 Apr 30.
Timely initiation of postoperative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC) is associated with improved survival, but rates of timely PORT initiation are low. To support uptake in a tertiary academic center, we aimed to identify implementation determinants (eg, barriers and facilitators) to timely PORT initiation and to design context-specific implementation strategies.
We created an implementation blueprint through a sequential mixed-methods study where we (1) identified determinants by fielding a 15-item survey based on the Theoretical Domains Framework (TDF), (2) prioritized determinants through focus groups with relevant stakeholders, (3) mapped barriers to implementation strategies using the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) matching tool, and (4) operationalized strategies using the Action, Actor, Context, Target, Time (AACTT) framework.
Twenty-three participants from three departments (61% Radiation Oncology, 35% Otolaryngology, 4% Medical Oncology) in a variety of roles (35% physicians, 39% nurses or advanced practice providers, 22% radiation therapists or dosimetrists, and 4% research coordinators) completed surveys. Participants identified 10 determinants affecting timely PORT initiation. After strategy selection and operationalization by focus group participants (n = 13), three ERIC strategies were selected for clinical implementation: remind clinicians, conduct educational meetings, and facilitate relay of clinical data to providers.
This work developed a menu of implementation strategies for future deployment to support timely PORT initiation. Codesign centered the voice of frontline workers, increasing the likelihood of successful implementation.
The systematic approaches to development can serve as a model for process improvement in other contexts.
对头颈部鳞状细胞癌（HNSCC）及时进行术后放疗（PORT）与生存率提高相关，但PORT及时启动率较低。为了在三级学术中心推动其应用，我们旨在确定PORT及时启动的实施决定因素（如障碍和促进因素），并设计针对具体情况的实施策略。
我们通过一项序贯混合方法研究创建了一个实施蓝图，其中我们（1）基于理论领域框架（TDF）进行一项15项调查来确定决定因素，（2）通过与相关利益相关者进行焦点小组讨论对决定因素进行优先级排序，（3）使用实施研究综合框架（CFIR）-实施变革专家建议（ERIC）匹配工具将障碍映射到实施策略，以及（4）使用行动、行动者、背景、目标、时间（AACTT）框架将策略付诸实施。
来自三个科室（61%为放射肿瘤学、35%为耳鼻喉科、4%为医学肿瘤学）的23名参与者，担任各种角色（35%为医生、39%为护士或高级实践提供者、22%为放射治疗师或剂量师、4%为研究协调员）完成了调查。参与者确定了10个影响PORT及时启动的决定因素。在焦点小组参与者（n = 13）进行策略选择和实施后，选择了三项ERIC策略用于临床实施：提醒临床医生、召开教育会议以及促进临床数据向提供者的传递。
这项工作制定了一系列实施策略以供未来部署，以支持PORT的及时启动。共同设计以一线工作人员的声音为中心，增加了成功实施的可能性。
这种系统的开发方法可作为其他情况下流程改进的模型。
