Developing Implementation Strategies for Promoting Integrative Oncology Outpatient Service Delivery and Utilisation: A Qualitative Study in Hong Kong

Abstract

Purpose: Current evidence supports the use of integrative oncology (IO) interventions in cancer supportive care. The demand for outpatient IO services in Hong Kong is expected to soar following the surge in cancer incidence in an ageing population. This study identified the implementation determinants of delivering and utilising outpatient IO from local stakeholders’ perspectives and developed corresponding implementation strategies. Methods: This study involved two sequential stages. First, with individual semi-structured interviews guided by the Theoretical Domains Framework (TDF), we explored stakeholders’ views on the barriers to and facilitators for implementing IO. Second, guided by a TDF-based qualitative data analysis of interview transcripts, we performed intervention mapping to develop Behaviour Change Wheel-based implementation strategies that may overcome the barriers and strengthen the facilitators. Results: We interviewed 31 stakeholders, including traditional Chinese medicine (TCM) practitioners (n=8), biomedically-trained doctors (n=7), nurses (n=6), administrators (n=4), caregivers (n=4), and pharmacists (n=2). The common local implementation determinants of IO are (1) lacking nursing and administrative manpower supporting IO service delivery, (2) lacking awareness of IO services among healthcare professionals, administrators, patients, and caregivers, and (3) lacking knowledge among healthcare professionals of herb–drug interaction and herbal toxicities. Conclusion: We recommended a multi-faceted implementation strategies package that included arranging additional funding to train, recruit, and retain experienced nursing and administrative staff, devolving resources into demonstrating successful interprofessional collaborations and clinical evidence on IO effectiveness and safety, integrating evidence on herb–drug interactions and herbal toxicities into automated electronic health record systems monitored by pharmacists with dual qualifications in TCM and conventional pharmacy.