Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

Abstract

Background In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation. Methods We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR. Results Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority). Conclusions Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators’ patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload. Trial registration Clinical Trial Registration Number NCT03514433, 5/2/2018.

Implementation of postpartum navigation for low-income individuals at an urban academic medical center

“…Navigator training and the support of care team members mitigated some of these challenges. These barriers and facilitators to implementation mirror those identified in existing literature that analyzes patient navigation in non-postpartum settings such as oncology [25][26][27]. Such concordance supports the use of implementation frameworks to identify barriers and facilitators to the implementation of postpartum patient navigation.…”

Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews

“…This process used three rounds of a modified-Delphi technique, followed by cognitive interviews, and deliberations among the research team, SAB, and PAB members to identify, operationalize, and pre-test CFIR survey items. Many studies using the CFIR to implement and evaluate clinical practices rely largely on qualitative methods to identify salient constructs [34][35][36][37][38][39]. Our approach is unique in employing an interactive process that begins with examining all CFIR constructs to prospectively and quantitatively examine implementation barriers and facilitators [15,17].…”

Integrating Accompanying Patients into Clinical Oncology Teams: Limiting and Facilitating Factors

“…In terms of high-quality formal and informal relationships and networks, it has been found that facilitators included robust administrative support, program functioning and team cohesion 13,15 . Conversely, developments in mental health peer support programs highlighted the fact that implementation in a healthcare setting can be hampered by role confusion, inadequate training of HPs working with peers or lack of professional development, and the slow pace of development 13,14,[27][28][29][30][31][32] .…”

“…To increase visibility, ongoing and repeated reminders that peer support is available through email noti cations or distribution of marketing material could be bene cial 13 . Indeed, frequent communication with HPs has shown to be helpful in peers meeting patients' needs through their discussions and in helping to successfully implement the peer support program 15,35,37 . Similarly, APs mentioned that creating opportunities to have discussions with team members is essential for ensuring their work is recognized.…”

“…Despite these positive effects of APs' intervention on patients, on the clinical team and on themselves, their overall integration has been rather complex. While a few studies have assessed the barriers and facilitating factors of integrating peers in different healthcare settings 12,13 , including oncology [14][15][16] , APs' perspectives on oncology clinical teams continue to be poorly documented. This study addresses the inner settings, individuals, and implementation process domains and related constructs regarding implementation of the PAROLE-Onco program in four institutions knowing that insu cient literature on APs' perspectives regarding limiting and facilitating factors in their integration into the clinical oncology teams.…”