Factors influencing fidelity to guideline implementation strategies for improving pain care at cancer centres: a qualitative sub-study of the Stop Cancer PAIN Trial.

Luckett, T; Phillips, J; Agar, M; Richards, L; Reynolds, N; Garcia, M; Davidson, P; Shaw, T; Currow, D; Boyle, F; Lam, L; McCaffrey, N; Lovell, M

Factors influencing fidelity to guideline implementation strategies for improving pain care at cancer centres: a qualitative sub-study of the Stop Cancer PAIN Trial.

Luckett, T

Phillips, J

Agar, M

Richards, L Reynolds, N Garcia, M

Davidson, P

Shaw, T

Currow, D

Boyle, F Lam, L

McCaffrey, N Lovell, M

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Publisher:: BMC
Publication Type:: Journal Article
Citation:: BMC Health Serv Res, 2024, 24, (1), pp. 969
Issue Date:: 2024-08-22

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Field	Value	Language
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Phillips, J https://orcid.org/0000-0002-3691-8230
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119
dc.contributor.author	Richards, L
dc.contributor.author	Reynolds, N
dc.contributor.author	Garcia, M https://orcid.org/0000-0002-9496-9546
dc.contributor.author	Davidson, P https://orcid.org/0000-0003-2050-1534
dc.contributor.author	Shaw, T https://orcid.org/0000-0003-0783-1918
dc.contributor.author	Currow, D https://orcid.org/0000-0003-1988-1250
dc.contributor.author	Boyle, F
dc.contributor.author	Lam, L https://orcid.org/0000-0001-6183-6854
dc.contributor.author	McCaffrey, N
dc.contributor.author	Lovell, M https://orcid.org/0000-0002-1407-2748
dc.date.accessioned	2024-09-18T03:35:27Z
dc.date.available	2024-06-25
dc.date.available	2024-09-18T03:35:27Z
dc.date.issued	2024-08-22
dc.identifier.citation	BMC Health Serv Res, 2024, 24, (1), pp. 969
dc.identifier.issn	1472-6963
dc.identifier.issn	1472-6963
dc.identifier.uri	http://hdl.handle.net/10453/180838
dc.description.abstract	BACKGROUND: The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives. METHODS: The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model. RESULTS: Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake. CONCLUSIONS: Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies. TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true .
dc.format	Electronic
dc.language	eng
dc.publisher	BMC
dc.relation.ispartof	BMC Health Serv Res
dc.relation.isbasedon	10.1186/s12913-024-11243-1
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0807 Library and Information Studies, 1110 Nursing, 1117 Public Health and Health Services
dc.subject.classification	Health Policy & Services
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4205 Nursing
dc.subject.classification	4206 Public health
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Australia
dc.subject.mesh	Cancer Care Facilities
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Guideline Adherence
dc.subject.mesh	Pain Management
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Quality Improvement
dc.subject.mesh	Humans
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Cancer Care Facilities
dc.subject.mesh	Guideline Adherence
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Quality Improvement
dc.subject.mesh	Pain Management
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Humans
dc.subject.mesh	Guideline Adherence
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Australia
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Pain Management
dc.subject.mesh	Middle Aged
dc.subject.mesh	Cancer Care Facilities
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Quality Improvement
dc.title	Factors influencing fidelity to guideline implementation strategies for improving pain care at cancer centres: a qualitative sub-study of the Stop Cancer PAIN Trial.
dc.type	Journal Article
utslib.citation.volume	24
utslib.location.activity	England
utslib.for	0807 Library and Information Studies
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Research Centres/IMPACCT
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Technologies (CHT)
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Research Centres
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated	2024-09-18T03:35:20Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	24
utslib.citation.issue	1

Abstract:

BACKGROUND: The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives. METHODS: The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model. RESULTS: Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake. CONCLUSIONS: Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies. TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true .

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