Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics
BackgroundFinancial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies ca...
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Health Services |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frhs.2023.1148887/full |
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| author | Victoria M. Petermann Victoria M. Petermann Caitlin B. Biddell Caitlin B. Biddell Arrianna Marie Planey Arrianna Marie Planey Lisa P. Spees Lisa P. Spees Donald L. Rosenstein Donald L. Rosenstein Donald L. Rosenstein Michelle Manning Mindy Gellin Neda Padilla Cleo A. Samuel-Ryals Cleo A. Samuel-Ryals Sarah A. Birken Sarah A. Birken Katherine Reeder-Hayes Katherine Reeder-Hayes Allison M. Deal Kendrel Cabarrus Ronny A. Bell Ronny A. Bell Carla Strom Carla Strom Tiffany H. Young Sherry King Brian Leutner Derek Vestal Stephanie B. Wheeler Stephanie B. Wheeler |
| author_facet | Victoria M. Petermann Victoria M. Petermann Caitlin B. Biddell Caitlin B. Biddell Arrianna Marie Planey Arrianna Marie Planey Lisa P. Spees Lisa P. Spees Donald L. Rosenstein Donald L. Rosenstein Donald L. Rosenstein Michelle Manning Mindy Gellin Neda Padilla Cleo A. Samuel-Ryals Cleo A. Samuel-Ryals Sarah A. Birken Sarah A. Birken Katherine Reeder-Hayes Katherine Reeder-Hayes Allison M. Deal Kendrel Cabarrus Ronny A. Bell Ronny A. Bell Carla Strom Carla Strom Tiffany H. Young Sherry King Brian Leutner Derek Vestal Stephanie B. Wheeler Stephanie B. Wheeler |
| author_sort | Victoria M. Petermann |
| collection | DOAJ |
| description | BackgroundFinancial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations.MethodsWe conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality.ResultsResults from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources.ConclusionsStaff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices. |
| first_indexed | 2024-03-11T16:33:11Z |
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| id | doaj.art-626715856f7f41bcb1bea567e1aaa415 |
| institution | Directory Open Access Journal |
| issn | 2813-0146 |
| language | English |
| last_indexed | 2024-03-11T16:33:11Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Health Services |
| spelling | doaj.art-626715856f7f41bcb1bea567e1aaa4152023-10-23T21:54:52ZengFrontiers Media S.A.Frontiers in Health Services2813-01462023-10-01310.3389/frhs.2023.11488871148887Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinicsVictoria M. Petermann0Victoria M. Petermann1Caitlin B. Biddell2Caitlin B. Biddell3Arrianna Marie Planey4Arrianna Marie Planey5Lisa P. Spees6Lisa P. Spees7Donald L. Rosenstein8Donald L. Rosenstein9Donald L. Rosenstein10Michelle Manning11Mindy Gellin12Neda Padilla13Cleo A. Samuel-Ryals14Cleo A. Samuel-Ryals15Sarah A. Birken16Sarah A. Birken17Katherine Reeder-Hayes18Katherine Reeder-Hayes19Allison M. Deal20Kendrel Cabarrus21Ronny A. Bell22Ronny A. Bell23Carla Strom24Carla Strom25Tiffany H. Young26Sherry King27Brian Leutner28Derek Vestal29Stephanie B. Wheeler30Stephanie B. Wheeler31School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesWake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United StatesWake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDivision of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesWake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United StatesWake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United StatesWake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United StatesWake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United StatesBuddy Kemp Support Center, Novant Health Cancer Institute, Charlotte, NC, United States0Carteret Health Care Cancer Center, Carteret, NC, United States1Pardee UNC Health Care, Hendersonville, NC, United States2UNC Lenoir Health Care, Kinston, NC, United StatesLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesBackgroundFinancial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations.MethodsWe conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality.ResultsResults from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources.ConclusionsStaff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices.https://www.frontiersin.org/articles/10.3389/frhs.2023.1148887/fullcancerfinancial toxicityfinancial navigationimplementation scienceruralorganizational readiness framework for advancing implementation science |
| spellingShingle | Victoria M. Petermann Victoria M. Petermann Caitlin B. Biddell Caitlin B. Biddell Arrianna Marie Planey Arrianna Marie Planey Lisa P. Spees Lisa P. Spees Donald L. Rosenstein Donald L. Rosenstein Donald L. Rosenstein Michelle Manning Mindy Gellin Neda Padilla Cleo A. Samuel-Ryals Cleo A. Samuel-Ryals Sarah A. Birken Sarah A. Birken Katherine Reeder-Hayes Katherine Reeder-Hayes Allison M. Deal Kendrel Cabarrus Ronny A. Bell Ronny A. Bell Carla Strom Carla Strom Tiffany H. Young Sherry King Brian Leutner Derek Vestal Stephanie B. Wheeler Stephanie B. Wheeler Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics Frontiers in Health Services cancer financial toxicity financial navigation implementation science rural organizational readiness framework for advancing implementation science |
| title | Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics |
| title_full | Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics |
| title_fullStr | Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics |
| title_full_unstemmed | Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics |
| title_short | Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics |
| title_sort | assessing the pre implementation context for financial navigation in rural and non rural oncology clinics |
| topic | cancer financial toxicity financial navigation implementation science rural organizational readiness framework for advancing implementation science |
| url | https://www.frontiersin.org/articles/10.3389/frhs.2023.1148887/full |
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