Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.
Keywords: cancer survivorship; cardiovascular health; digital health; implementation science; mixed methods.
Digital health tools improve patient care, yet they can be challenging to add to and use in clinical care. We studied using a digital health tool, the Automated Heart-Health Assessment (AH-HA) tool, that supports oncology care teams discussing heart health with their cancer survivor patients. Surveys and interviews were used to collect data on barriers and facilitators to using the AH-HA tool in four clinical practices. All providers felt that discussing cardiovascular health with their patients was important. The tool was well-received by providers and could be used successfully in routine care among cancer survivors. Providers liked the tool and found it easy to use, felt it improved the care they provided, and had the potential to generate benefits for their patients. The most common reasons clinicians reported not using the tool were lack of time and the tool not fitting with their workflow. We will use the study findings to improve the AH-HA tool and select strategies to support its use in other care settings. Lessons learned from this study can enhance the use of other similar tools to improve patient care in many clinical care settings.
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