Using Implementation Science to Promote the Use of the G8 Screening Tool in Geriatric Oncology

Abstract

OBJECTIVES Evidence supports the integration of geriatric assessment in the care of older adults with cancer. The G8 screening tool is a validated instrument to target a geriatric assessment. Use of the G8 tool in clinical practice, however, is suboptimal. We systematically analyzed the barriers and facilitators to G8 tool use in oncology clinics and selected interventions tailored to the local context to enhance its uptake. DESIGN This qualitative study used semistructured interviews and site observations. SETTING St. Michael's Hospital, Toronto, Canada. PARTICIPANTS Ten participants including G8 tool adopters and stakeholders at St. Michael's Hospital were interviewed. MEASUREMENTS An interview guide based on the Theoretical Domains Framework (TDF) was developed to identify beliefs about G8 tool use. Barriers and facilitators to G8 tool use were mapped to the TDF domains and corresponding intervention functions from the Capability, Opportunity, Motivation, and Behavior model. Evidence‐based implementation strategies were selected from two databases. RESULTS Key TDF domains influencing G8 tool use behavior were social/professional role, goals, beliefs about consequences, and social influences. The behavior change domains were mapped to four mechanisms of change: persuasion (conduct local consensus discussions), modeling (identify and prepare a champion), education (distribute educational materials), and enablement (use materials to prepare patients to be active participants in understanding the evidence behind the G8 tool and answering questions accurately). CONCLUSION This study identified barriers to G8 tool use. Local consensus discussions, identifying and preparing a champion, using educational materials, and preparing patients to be active participants may be implementation strategies to improve G8 tool use. J Am Geriatr Soc 67:898–904, 2019.

Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists

“…The 14 TDF domains are linked to a taxonomy of behaviour change techniques (BCTs) [15], which are the “building blocks” of behaviour change interventions. The TDF has been applied extensively to develop interventions targeting practitioners’ behaviours including promoting uptake of a screening tool in geriatric oncology [16].…”

Le myélome multiple chez la personne âgée : impact d’une évaluation gériatrique

“…2 Ainsi, l'utilisation en routine d'une évaluation gériatrique pour les patients âgés oncologiques est recommandée par le National Comprehensive Cancer Network (NCCN) 3 et l'European Organization for Research and Treatment of Cancer et l'International Society of Clinical Oncology. 4 Pour autant, cette évaluation n'est pas faite de manière systématique. 4,5 Gulasigam et coll.…”

“…4 Pour autant, cette évaluation n'est pas faite de manière systématique. 4,5 Gulasigam et coll. ont montré les nombreuses barrières que les médecins ont à réaliser ces évaluations (ne voient pas les bénéfices, manque de motivation, etc.).…”

Geriatric Oncology: Getting Even Better with Age

“…As the evidence base develops, next steps will include providing data to support personalized management, developing novel trial designs, pioneering new approaches to care delivery, and ultimately implementing results into practice at the level of the individual and the healthcare system. Research presented in this issue highlights challenges and opportunities in effecting change, which includes implementing geriatric screening, testing rehabilitation for vulnerable older adults with cancer, and decreasing aggressive care at the end of life …”

“…Research presented in this issue highlights challenges and opportunities in effecting change, which includes implementing geriatric screening, testing rehabilitation for vulnerable older adults with cancer, and decreasing aggressive care at the end of life. [25][26][27] Geriatric oncology is coming of age. Its success will continue to be fostered by the dedication of a passionate and collaborative national and international community of investigators, clinicians, educators, and advocates.…”