Abstract
Context
The American Society of Clinical Oncology (ASCO) recommends that outpatient specialty
palliative care (OSPC) be offered within eight weeks of an advanced cancer diagnosis.
To meet the rising demand, there has been an increase in the availability of OSPC
services at National Cancer Institute (NCI)-designated cancer centers; however, many
OSPC referrals still occur late in the disease course.
Objectives
Using the Consolidated Framework for Implementation Research (CFIR), we evaluated
facilitators and barriers to early OSPC implementation and associated clinic characteristics.
Methods
We selected relevant CFIR constructs for inclusion in a survey that was distributed
to the OSPC clinic leader at each NCI-designated cancer center. For each statement,
respondents were instructed to rate the degree to which they agreed on a five-point
Likert scale. We used descriptive statistics to summarize responses to survey items
and explore differences in barriers based on OSPC clinic size and maturity.
Results
Of 60 eligible sites, 40 (67%) completed the survey. The most commonly agreed upon
barriers to early OSPC included inadequate number of OSPC providers (73%), lack of
performance metric goals (65%), insufficient space to deliver early OSPC (58%), logistical
challenges created by early OSPC (55%), and absence of formal interdisciplinary communication
systems (53%). The most frequently reported barriers differed according to clinic
size and maturity.
Conclusion
Most barriers were modifiable in nature and related to the “Inner Setting” domain
of the CFIR, which highlights the need for careful strategic planning by leadership
when implementing early OSPC.
Key Words
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Article info
Publication history
Published online: November 29, 2022
Accepted:
November 16,
2022
Footnotes
Prior Presentations: The preliminary results of this study were presented at the 2022 ASCO Annual Meeting in Chicago, Illinois, USA.
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
