The following is a summary of the “National Survey Using CFIR to Assess Early Outpatient Specialty Palliative Care Implementation,” published in the March 2023 issue of Pain and Symptom Management by Rosenblum, et al.
Within 8 weeks of a diagnosis of advanced cancer, the American Society of Clinical Oncology (ASCO) suggests providing access to outpatient specialty palliative care (OSPC). National Cancer Institute (NCI) designated cancer centers have expanded their OSPC service offerings to keep up with demand, but many patients are referred to these facilities late in the disease process. In this study, the researchers used the CFIR to analyze the factors that helped and hindered the initial stages of OSPC implementation and the characteristics of the clinics where these initiatives were implemented.
The researchers included pertinent CFIR constructs in a survey sent to the OSPC clinic director at every cancer center with an NCI designation. Respondents were asked to indicate how much they agreed with each statement using a Likert scale from one (strongly disagree) to five (completely agree). They used descriptive statistics to examine differences in barriers based on the size and maturity of OSPC clinics and to summarise responses to survey items. Only 40 (or 67%) of the 60 possible locations filled out the survey.
There is a lack of OSPC providers (73% agreed), there is a lack of performance metric goals (65% agreed), there is a lack of space to deliver early OSPC (58% agreed), there are logistical challenges brought on by early OSPC (55% agreed), and there are no formal interdisciplinary communication systems (53%) agreed. The most commonly cited challenges varied by clinic size and level of development. The importance of careful strategic planning by leadership to implement early OSPC is highlighted by the fact that most barriers were modifiable in nature and related to the “Inner Setting” domain of the CFIR.