Abstract
The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high-quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.
Highlights
The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs [1]
The proposed conceptual framework for a high-quality cancer delivery system highlights the importance of engaging patients and their families, providing evidence-based care, and translating the evidence into routine clinical care
It has been suggested that an average of 17 years elapses before 14% of original research is integrated into routine physician practice (Figure 1) [4]. This gap between the identification of beneficial research findings and the application in clinical practice has led to an increased focus on the processes for implementing new knowledge and the rapidly growing field of dissemination and implementation (D&I) science [5,6,7,8,9]
Summary
Tabak et al categorized the theories and models relevant to D&I research according to their focus on dissemination and/or implementation activities and the socio-ecological level to which they are applicable [20] They rated the flexibility of the model constructs, ranging from a score of 1 (very loose construct definition allowing researchers maximal flexibility in applying the model) to 5 (more defined constructs providing researchers with a more operational, stepby-step approach to D&I research activities). Dissemination and implementation theoretical models provide a systematic approach to developing and evaluating the implementation of interventions Within these frameworks, specific implementation strategies can be selected that match the needs of a clinical program or practice [16, 17]. It is critical to consider the context in which an intervention will be implemented
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