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Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study

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Abstract

Objectives

Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial.

Methods

Guided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes.

Results

We conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership “champions.”

Conclusions

Findings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology.

Trial Registration

ClinicalTrials.gov #NCT02941614

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Funding

This project was supported by funds provided by The Regents of the University of California, Research Grants Program Office, California Breast Cancer Research Program, Grant Number 22OB-0029. The opinions, findings, and conclusions herein are those of the author and do not necessarily represent those of The Regents of the University of California or any of its programs.

Author information

Authors and Affiliations

  1. Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA

    Erin E. Hahn, Corrine E. Munoz-Plaza, Lindsay Joe Lyons, Janet S. Lee & Dana Pounds

  2. Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Erin E. Hahn & Michael K. Gould

  3. Southern California Permanente Medical Group Performance Assessment team (as of 11/2020), Pasadena, CA, USA

    Dana Pounds

  4. Cancer Support Community, Los Angeles, CA, USA

    Shannon La Cava

  5. Southern California Permanente Medical Group, Department of Medical Oncology, Anaheim, CA, USA

    Farah M. Brasfield

  6. Southern California Permanente Medical Group, Department of Medical Oncology, South Bay, CA, USA

    Lara N. Durna

  7. Southern California Permanente Medical Group, Department of Medical Oncology, Los Angeles, CA, USA

    Karen W. Kwan

  8. Southern California Permanente Medical Group, Department of Medical Oncology, Woodland Hills, CA, USA

    David B. Beard

  9. Southern California Permanente Medical Group, Department of Medical Oncology, West Los Angeles, CA, USA

    Alexander Ferreira

Authors
  1. Erin E. Hahn
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  2. Corrine E. Munoz-Plaza
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  12. Michael K. Gould
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Contributions

EEH, CMP, and MKG generated the idea for the study and designed the study. CMP and EEH led the drafting of the manuscript. CMP, DP, and LJL prepared approval applications, provided project management, contributed to the interview guide, and coordinated recruitment. DP and JSL identified eligible patients, administrators, and clinicians for recruitment. SLC, FMB, LND, KWK, DBB, and AF contributed clinical expertise to the interview guide. CMP and EEH oversaw development of the interview guide, and CMP and LJL conducted interviews. CMP, EEH, and LJL conducted the analyses. All authors contributed to the drafting of the manuscript and read and approved the final manuscript. We would like to acknowledge our interview participants for giving of their time for our study.

Corresponding author

Correspondence to Erin E. Hahn.

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Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki and all study activities were approved by the Kaiser Permanente Southern California Institutional Review Board (IRB) #11103. Verbal consent was obtained for all participants.

Competing interests

The authors declare no competing interests.

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Hahn, E.E., Munoz-Plaza, C.E., Lyons, L.J. et al. Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study. Support Care Cancer 31, 461 (2023). https://doi.org/10.1007/s00520-023-07922-0

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