Investigating the Pre-Implementation Facilitators and Barriers of the Implementation of the Fear of Recurrence Therapy (FORT) Intervention in Canadian Cancer Centers.

Abstract

Objectives: Fear of cancer recurrence (FCR) is the number one unmet psychosocial need of cancer survivors. Fortunately, several interventions have demonstrated their efficacy in reducing FCR in randomized controlled trials (RCTs), including the Fear of Recurrence Therapy (FORT) intervention, a 6-week, cognitive-existential group therapy. However, few interventions are implemented in routine clinical care. The present study aims to document pre-implementation facilitators and barriers from the perspectives of clinicians and decision-makers to prepare the implementation of FORT in Canadian cancer centers.

Methods: This mixed-methods comparative case study evaluated the process of implementing FORT in 5 Canadian clinical sites. Prior to implementation, we conducted individual semi-structured interviews with clinicians and decision-makers at each site, based on the Consolidated Framework for Implementation Research (CFIR), to uncover barriers and facilitators of implementation. Content analysis was performed on the interviews using the NVivo template provided by the CFIR.

Results: We interviewed 20 managers/decision-makers and clinicians who reported facilitators common to all sites: (1) an awareness of the need for an FCR intervention; (2) the perceived benefit of FORT's group format to reduce waitlists for individual FCR services; and (3) that offering an evidence-based intervention was within the mission of their institution. All sites identified staff shortage and concerns for equitable access to FORT as the main barriers. Each site had additional unique barriers.

Conclusion: This analysis of facilitators and barriers will directly contribute to the selection of site-specific strategies and tools to optimize the implementation of FORT.