Determinants of implementation and integration of specialist cancer support in a children's healthcare service
Hugh Fulham-McQuillan, Maryanne Murphy, Maria Brenner, Agnes HigginsBackground/Aims
It has been recognised that, although some families of children with cancer will require formal psychological support, for many families a less formal model of support would be more appropriate. A cancer service in Ireland implemented a cancer specialist support service to provide this informal psychosocial support. This study aimed to identify and describe the barriers and enablers to the implementation and integration of this service.
Methods
A total of 31 participants were interviewed as part of this qualitative study, of which 23 were staff members from the multidisciplinary team (including cancer support specialists) and eight were parents of children with cancer. Semi-structured interviews were conducted, recorded and transcribed. The Consolidated Framework for Implementation Research was used to guide the analysis and generate themes.
Results
Three key themes were identified, containing two challenges and four enablers of implementation. Enablers included flexibility of the cancer support specialist roles, as well as the liminal nature of these roles and the individual characteristics of the role holders themselves. Extensive engagement to resolve challenges and willingness to adapt role descriptions were also key enablers. Challenges included coordinating communication about the implementation process and a lack of clarity around the roles and their boundaries.
Conclusions
Informal psychosocial support is clearly valuable but integrating it into formal healthcare settings takes thoughtful design, clear role boundaries and ensuring that the right people are in the roles.
Implications for practice
Successful integration of specialist cancer support services depends on clear governance, multidisciplinary collaboration and organisational commitment. Embedding these roles within routine children's cancer care could strengthen child- and family-centred cancer care and improve the coordination of psychosocial support across the cancer trajectory.