Highlights
- •Implementation science is the systematic study of factors leading to sustained use of evidence-based interventions.
- •Implementation science frameworks can lend methodological rigor to studies of access to gynecologic cancer care.
- •The CFIR framework considers aspects of Innovation, Inner Setting, Outer Setting, Individuals, and Implementation Process.
- •We recommend moving past associational studies in favor of systematic assessment and correction of specific barriers to care.
Abstract
Introduction
Barriers to access to cancer care are profoundly threatening to patients with gynecologic
malignancies. Implementation science focuses on empirical investigation of factors
influencing delivery of clinical best practices, as well as interventions designed
to improve delivery of evidence-based care. We outline one prominent framework for
conducting implementation research and discuss its application to improving access
to gynecologic cancer care.
Methods
Literature on the use of the Consolidated Framework for Implementation Research (CFIR)
was reviewed. Delivery of cytoreductive surgery for advanced ovarian carcinoma was
selected as an illustrative case of an evidence-based intervention (EBI) in gynecologic
oncology. CFIR domains were applied to the context of cytoreductive surgical care,
highlighting examples of empirically-assessable determinants of care delivery.
Results
CFIR domains include Innovation, Inner Setting, Outer Setting, Individuals, and Implementation
Process. “Innovation” relates to characteristics of the surgical intervention itself;
“Inner Setting” relates to the environment in which surgery is delivered. “Outer Setting”
refers to the broader care environment influencing the Inner Setting. “Individuals”
highlights attributes of persons directly involved in care delivery, and “Implementation
Process” focuses on integration of the Innovation within the Inner Setting.
Conclusions
Prioritization of implementation science methods in the study of access to gynecologic
cancer care will help ensure that patients are able to utilize interventions with
the greatest prospect of benefiting them.
Keywords
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Article info
Publication history
Published online: March 25, 2023
Accepted:
March 16,
2023
Received in revised form:
March 10,
2023
Received:
February 24,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
