Canadian Pediatric Oncology Nurses' Perspectives on Implementation of the Children's Oncology Group KidsCare Customized App.

Background: Canada represents half of the Children's Oncology Group (COG) sites that have opted to customize content for families within the COG KidsCare app. It was unclear how many sites proceeded with developing and inputting customized content and how well the app and customized content were implemented into practice. This raised concerns that Canadian families were unaware of this new digital resource and did not have equitable access to customized content. This qualitative study aimed to understand nursing site leads' experiences including perspectives on facilitators and barriers to customization and implementation of the COG's KidsCare app. Method: Semi-structured interviews with clinicians who self-reported expertise in patient and family education local practices were conducted. Transcripts were independently coded by two team members using an iterative hybrid inductive/deductive approach, and analyzed using the Consolidated Framework for Implementation Research (CFIR), to summarize results. Results: The facilitators and barriers to implementing the COG KidsCare app with customization were categorized by five overarching CFIR-related themes: (a) features of the customized COG KidsCare app, (b) external environment, (c) institutional environment, (d) implementation team, and (e) the process of implementing and customizing the COG KidsCare app. Discussion: Nurses expressed feelings of tension between support and perceived value of the COG KidsCare app with customization, and their ability to successfully create, refine, implement content and disseminate to families. Using our RoadMap of recommended implementation strategies to integrate use of the app into practice may provide opportunity for successful implementation in a variety of contexts.