(NSP-03) Establishing Barriers and Enablers to Nurse-enabled, Subcutaneous Therapy Self-administration Programs for Myeloma Patients - Description of an Implementation Science Study Design

Introduction: Multiple myeloma (MM) carries the highest symptom burden of all blood cancers, with patients often requiring multiple lines of treatment over many years. Subcutaneous (SC) injections are a common delivery method for both current and emerging therapies. Experience from our nurse-enabled, subcutaneous therapy self-administration program (NESTSP)—which allows patients or carers to administer SC treatments at home—has resulted in reduced hospital visits, lower time and cost burden of treatment, improved quality of life (QoL), and increased healthcare capacity.

Despite these benefits, implementing this model in other healthcare settings has proven challenging, largely due to the complexity and variability of healthcare environments. Implementation Science (IS) has emerged as an evidence-based approach to study and understand how best to support, embed, and sustain evidence-based innovations in different contexts.

Here we describe an IS-informed approach to explore barriers and enablers to implementing NESTSPs, guided by the Consolidated Framework for Implementation Research (CFIR) and the CFIR–Expert Recommendations for Implementing Change (ERIC) matching tool. Applying the CFIR and CFIR–ERIC matching tool provides an evidence-informed approach to understanding how discrete and intersecting factors influence program implementation and sustainability. Data generated will inform the development of a national Implementation Roadmap for NESTSPs.

Methods: A qualitative descriptive study was undertaken. Participants included key stakeholders from across the country, including patients, carers, health professionals, industry representatives, and policy makers with experience of implementation, facilitation, and participation in NESTSPs. Purposive sampling was used to ensure recruitment included participants with and without experience of successful implementation of a NESTSP. Data were collected via virtual focus groups or semi-structured interviews, and analysis was guided by the Framework Method to explore barriers and enablers according to the domains and constructs of the CFIR. The CFIR–ERIC matching tool was used to develop strategies to target barriers and enhance enablers. These strategies will be reviewed and refined in a future study with two regional cancer centres to inform the development of a national Implementation Roadmap.

Results: n/a

Conclusions: To our knowledge, this study is the first to identify and compare barriers and enablers to implementing NESTSPs for patients with MM. The implications of this work extend beyond MM due to the increasing use of SC therapies for myeloma, other cancers and chronic diseases. Approaches that enable patients to safely self-administer effective treatments could positively impact patient QoL and optimise healthcare utilisation.