Research Article| Volume 172, P78-81, May 2023

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An implementation science approach to the systematic study of access to gynecologic cancer care

  • David I. Shalowitz
    Corresponding author at: West Michigan Cancer Center, 200 N. Park St., Kalamazoo, MI 49007, USA.
    West Michigan Cancer Center, Kalamazoo, MI, United States of America

    Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America
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  • Mary C. Schroeder
    Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America

    Division of Health Services Research, College of Pharmacy, University of Iowa, Iowa City, IA, United States of America
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  • Sarah A. Birken
    Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America

    Department of Implementation Science, School of Medicine, Wake Forest University, Winston-Salem, USA
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      • 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.



      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.


      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.


      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.


      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.


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