Integrating Implementation Theory to Address Inequities in Cancer Care: Perspectives from an International Working Group

Abstract

Background . There are well-established, persistent inequities in cancer care and cancer outcomes within and between countries. The aim of this article is to explore how implementation theory, specifically the Consolidated Framework for Implementation Research (CFIR), alongside coproduction principles, could be used to maximise the effectiveness of innovations with a vision of reducing inequity in cancer care. Methods. Workshops were conducted with partners from US, Australia, and UK, participating in the University Global Partnership Network (UGPN), which funded the collaboration. From these workshops, three case studies were identified and the framework was applied to identify ways of using CFIR to maximise the effectiveness of innovations. Results. The three case studies focused on human papillomavirus (HPV) testing and vaccination, participation in clinical trials, and use of translation services. We identified opportunities, for each of the case studies, where CFIR could be applied to improve implementation and proposed recommendations to ensure effective implementation of innovations using CFIR domains, including individual constructs (e.g., awareness and cultural competence), inner setting constructs (e.g., technology infrastructure), and outer setting constructs (e.g., how services are monitored, evaluated, and commissioned). Conclusions. Applying CFIR as an implementation framework offers a structured and holistic approach to consider how to maximise the effectiveness of innovations in the context of reducing inequities in cancer care. Working with other countries to apply this framework also provides a uniform approach to understand and reduce inequities across a range of innovations and address the global mission to improve cancer care for all.