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A Leap From Evidence to Practice

Implementation Science in Cancer Nursing

Lin, Chia-Chin PhD, RN, FAAN; Xu, Xinyi BSN, RN

doi: 10.1097/NCC.0000000000000714
DEPARTMENTS: Guest Editorial
Free

Editorial Board Member, Cancer Nursing Professor and Head School of Nursing, Li Ka Shing Faculty of Medicine The University of Hong Kong, Hong Kong

School of Nursing, Li Ka Shing Faculty of Medicine The University of Hong Kong, Hong Kong

The authors have no funding or conflicts of interest to disclose.

Evidence-based practice is the criterion standard for improving clinical outcomes and quality of patient care across institutions and hospitals. Evidence, however, even with rigorously proven effectiveness and efficacy, does not spontaneously translate into practice. Symptom management has been the priority of oncology nursing research for decades. However, pain and cancer/treatment-related symptoms continue to be undertreated.1 Such a research-practice gap is also present in cancer screening and other preventive measures, such as vaccinations and smoking interventions. A reduction in the research-practice gap is associated with a reduction in healthcare cost and patient mortality, but it is difficult to implement a new intervention across a broad spectrum of settings.2 In fact, it takes an average of 17 years for new scientific evidence to reach routine clinical practice.3 To address the discrepancy between evidence and clinical practice, oncology nursing research has started paying more attention to implementation science.2

Implementation science studies the process of implementation of evidence-based practice. It helps oncology nursing professionals, researchers, and policymakers to identify methods and strategies to promote the implementation of effective interventions in routine cancer care. Often, oncology nursing professionals are the implementers of new interventions, and their clinical experience makes them indispensable for identifying problems and challenges in real-world contexts. Yet, changing the established practice pattern in unique settings is a complex process, and it requires more than clinical experience and nursing intuition. Implementation science systematically studies factors that might influence the process of implementation of an intervention, including feasibility, fidelity, cost, and organizational policy. Additionally, implementation science compares the effectiveness of different implementation approaches and provides guidance for future implementers. For example, human papillomavirus (HPV) vaccine can prevent most cases of cervical cancer, but the uptake of the vaccine is still suboptimal in Hong Kong.4 The evidence-practice gap in HPV vaccination could be multifaceted, potentially hindered by the high cost of the vaccine, the burden of frequent office visits, gender stigma, and lack of relevant health education in parents. Using structure frameworks and models from implementation science, oncology nursing researchers can pinpoint the exact factors influencing the poor uptake of HPV vaccine. Parents with limited knowledge of the vaccine might be unlikely to participate. Therefore, as a next step, different educational approaches need to be tested. The timing (at what age of the child), setting (at the doctor’s office or at school), and mode (written material or video) of the education delivery can all impact the effectiveness of the intervention. The findings would provide important implications for oncology nurses to promote HPV vaccination and cancer prevention programs at large.

Providing quality care to the expanding population of cancer patients and survivors is a major challenge in public health. Therefore, it is critical to make the leap from evidence to clinical practice, to meet the increasing demand of optimal cancer care. A systematic review on implementation science in cancer care has found that the number of publications investigating the evidence-practice gap has increased; however, most studies continue to describe the characteristics of the gaps, rather than testing interventions to reduce or close these gaps.2 Of the 160 identified publications, 94% were descriptive studies, and only 6% were intervention studies. Further, the number of intervention studies did not increase over a 10-year period. Intervention studies are more complex, expensive, and time intensive, and they often require multidisciplinary collaboration. While descriptive studies provide important information regarding the research-practice gap, intervention research maximizes the benefit of studies by comparing the effectiveness of approaches in optimizing cancer care.2

Implementation science is a growing priority for major healthcare funders, such as the National Institutes of Health in the United States and the Research Fund Secretariat in Hong Kong. Therefore, in the future, oncology nursing researchers should take advantage of the growing opportunities in implementation science. To translate the best of the oncology nursing findings into clinical practice, researchers ought to focus more on (1) determining barriers impeding the implementation process, (2) evaluating the effectiveness of different intervention delivery modes, and (3) developing strategies to better facilitate the implementation process. By expanding the field of implementation science and increasing productivity in this research area, we will maximize the impact of oncology nursing research on nursing care and thereby facilitate the provision of a higher level of care for cancer patients in need.

With all best wishes,

Chia-Chin Lin, PhD, RN, FAAN

Editorial Board Member, Cancer Nursing

Professor and Head

School of Nursing, Li Ka Shing Faculty of Medicine

The University of Hong Kong, Hong Kong

Xinyi Xu, BSN, RN

School of Nursing, Li Ka Shing Faculty of Medicine

The University of Hong Kong, Hong Kong

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References

1. O’Mara AM, St Germain D, Ferrell B, Bornemann T. Challenges to and lessons learned from conducting palliative care research. J Pain Symptom Manage. 2009;37(3):387–394.
2. Bryant J, Boyes A, Jones K, Sanson-Fisher R, Carey M, Fry R. Examining and addressing evidence-practice gaps in cancer care: a systematic review. Implement Sci. 2014;9(1):37.
3. Skolarus TA, Sales AE. Using implementation science to improve urologic oncology care. Urol Oncol. 2016;34(9):384–387.
4. Choi HC, Leung GM, Woo PP, Jit M, Wu JT. Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: a survey of mothers and adolescents. Vaccine. 2013;32(1):78–84.
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