Science in the Heartland: Exploring determinants of offering cancer clinical trials in rural-serving community urology practices

Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology

“…Aim 2 measures are derived from the constructs identified in the Theoretical Domains Framework (TDF). We selected the TDF as our determinant model [25] based on its relevance in previous work to understand the determinants of other cancer specialists' treatment behavior [22,59]. The TDF also integrates with the Behavior Change Wheel (BCW) approach to implementation strategy design [60], consistent with our overarching intention to design implementation strategies to support appropriate targeted therapy [61].…”

“…We will also make available external contractors to abstract the remaining data elements should participating sites not have capacity. Nonetheless, we will collect the qualitative data first and anticipate that much can be gleaned from determinant analysis relying on physician self-report of TT use if necessary, as we have established in other studies [23,59]. Delayed collection could provide opportunities for validation of the two approaches, providing additional methodological contributions of this project.…”

“…For qualitative research, sample adequacy is determined by saturation rather than effect size [52]. Based on similar studies [23], we estimate 4 sites of each practice type (high vs low adherers) will be adequate to reach saturation but will monitor the need for additional site recruitment if participant responses are not consistent and saturation is not reached.…”

“…However, many domains relevant to the adoption and implementation of novel, guideline-based TTs (e.g., BRAF testing in metastatic melanoma) have not been assessed. Individual physician-level factors have been demonstrated to be influential in test ordering and prescribing decisions in other contexts [22,23]. However, little is known about health care providers' influences around using targeted therapy [24,25].…”

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“…The BCW organization of the different determinant domains facilitates understanding of the implications of behavioral changes [27,28]. We chose the TDF among the popular determinant frameworks based on our substantial experience with the framework [39][40][41][42], its comprehensiveness of a full range of potential determinants, its thorough exploration of individual motivation pertinent to individual healthcare providers' prescribing decisions, and its utility in combination with the BCW in implementation strategy selection, with the latter two reasons distinguishing it from other popular frameworks.…”