Laila A Gharzai, Jaymie Bromfield, Michelle Kwan, Alexis Larson, Janine A Kingsbury, Adil Akthar, Gaurava Agarwal, Julia H Vermylen, Sara Becker, Kelli Scott, Amelia E Van Pelt, Katelyn O Stepan
{"title":"实施绘图以确定增加头颈癌术后及时放射治疗的策略。","authors":"Laila A Gharzai, Jaymie Bromfield, Michelle Kwan, Alexis Larson, Janine A Kingsbury, Adil Akthar, Gaurava Agarwal, Julia H Vermylen, Sara Becker, Kelli Scott, Amelia E Van Pelt, Katelyn O Stepan","doi":"10.1002/ohn.1268","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Implications for practice: </strong>The systematic approaches to development can serve as a model for process improvement in other contexts.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implementation Mapping to Identify Strategies to Increase Timely Postoperative Radiotherapy Initiation for Head/Neck Cancer.\",\"authors\":\"Laila A Gharzai, Jaymie Bromfield, Michelle Kwan, Alexis Larson, Janine A Kingsbury, Adil Akthar, Gaurava Agarwal, Julia H Vermylen, Sara Becker, Kelli Scott, Amelia E Van Pelt, Katelyn O Stepan\",\"doi\":\"10.1002/ohn.1268\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Implications for practice: </strong>The systematic approaches to development can serve as a model for process improvement in other contexts.</p>\",\"PeriodicalId\":19707,\"journal\":{\"name\":\"Otolaryngology- Head and Neck Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Otolaryngology- Head and Neck Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ohn.1268\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otolaryngology- Head and Neck Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ohn.1268","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
Implementation Mapping to Identify Strategies to Increase Timely Postoperative Radiotherapy Initiation for Head/Neck Cancer.
Objective: 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.
Methods: 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.
Results: 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.
Discussion: 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.
Implications for practice: The systematic approaches to development can serve as a model for process improvement in other contexts.
期刊介绍：
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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