Abstract
BackgroundEffective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success. Research methods that draw on recognised implementation frameworks, such as the Promoting Action Research in Health Services (PARiHS) framework, and that test feasibility to gain information prior to full-scale roll-out, can support a more structured approach to implementation.ObjectiveThis paper presents qualitative findings from a feasibility study in one cancer service of an online portal to operationalise a clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients. The aim of this study was to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation in order to inform the full-scale roll-out.MethodsSemi-structured interviews were conducted with fifteen hospital staff holding a range of clinical, administrative and managerial roles, and with differing levels of exposure to the pathway. Qualitative data were analysed thematically, and themes were subsequently organised within the constructs of the PARiHS framework.ResultsBarriers and facilitators that affected the feasibility of the online portal and implementation strategies were organised across eight key themes: staff perceptions, culture, external influences, attitudes to psychosocial care, intervention fit, familiarity, burden and engagement. These themes mapped to the PARiHS framework’s three domains of evidence, context and facilitation.ConclusionsImplementation success may be threatened by a range of factors related to the real-world context, perceptions of the intervention (evidence) and the process by which it is introduced (facilitation). Feasibility testing of implementation strategies can provide unique insights into issues likely to influence full-scale implementation, allowing for early tailoring and more effective facilitation which may save time, money and effort in the long-term. Use of a determinant implementation framework can assist researchers to synthesise and effectively respond to barriers as they arise. While the current feasibility study related to a specific implementation, strategies such as regular engagement with local stakeholders, and discussion of barriers arising in real-time during early testing is likely to be of benefit to all researchers and clinicians seeking to maximise the likelihood of long-term implementation success.
Highlights
Effective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success
Implementation success may be threatened by a range of factors related to the real-world context, perceptions of the intervention and the process by which it is introduced
While the current feasibility study related to a specific implementation, strategies such as regular engagement with local stakeholders, and discussion of barriers arising in real-time during early testing is likely to be of benefit to all researchers and clinicians seeking to maximise the likelihood of long-term implementation success
Summary
Effective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success. To improve the likelihood of successful implementation, recent guidance from the United Kingdom Medical Research Council recommends early assessment of the feasibility of key components underlying the implementation process prior to a full evaluation [8] This small scale realworld testing allows researchers to observe the process of translating research into practice, identify barriers that may not have been evident during the development phase, and develop strategies for facilitating smoother implementation in the long-term [9]. Within implementation science, such feasibility studies seek to assess aspects of the implementation process rather than the intervention. Frontline staff are intimately involved with the implementation of any new intervention, and can contribute vital information about the feasibility of key components
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