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

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.