Site Reviewer Perspectives on the Implementation of the Commission on Cancer Operative Standards.

Background: To reduce technical variation in cancer surgery, the Commission on Cancer (CoC) recently implemented six operative standards as part of its national cancer center accreditation process. CoC sites are evaluated for compliance with these standards through scheduled visits conducted by trained site reviewers. We characterized site reviewers' perspectives on the implementation of the operative standards.

Study design: Twenty interviews were conducted with CoC site reviewers using a semi-structured interview guide based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Themes were identified using thematic analysis, mapped to the updated Consolidated Framework for Implementation Research (CFIR).

Results: Site reviewers viewed the operative standards as an effective starting point for improving technical quality and were optimistic the standards would lead to positive change. Compliance was associated with supportive site leadership, effective interdisciplinary communication, and the availability of adequate personnel and institutional resources. In contrast, resistance from surgeons was identified as a key barrier. CoC site reviewers interpret their role as extending beyond assessing compliance, viewing themselves as advocates, educators, and partners to the sites.

Conclusions: Overall, CoC site reviewers perceive the operative standards favorably. To enhance implementation of the operative standards, efforts should focus on modifiable institutional and individual level factors, such as leadership support and surgeon engagement. Additionally, the multifaceted role of the site reviewers presents a valuable opportunity to improve compliance by formalizing the supportive relationship between reviewers and sites.