Evaluating potential determinants of health system implementation of a virtual oncology financial and legal navigation intervention to address cancer-related financial toxicity

Background: Integration of comprehensive oncology financial and legal navigation (OFLN) programs within health systems are needed to address cancer-related financial toxicity, however, implementation challenges exist. Objectives: The aim of this study was to assess contextual factors that may influence implementation of a virtual OFLN intervention within a pediatric and adolescent and young adult oncology clinic and to inform necessary modifications to the proposed implementation strategies, pathways, and workflows. Methods: We conducted 18 key informant interviews with healthcare team members, patients and caregivers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR) to provide a structured evaluation and framework to tailor the implementation of the proposed virtual OFLN intervention. Interviews were recorded, transcribed, and analyzed by two independent coders and organized as facilitators and barriers to implementation within each CFIR domain. Results: We identified ten potential implementation facilitators related to high demand and need for OFLN services, adaptability of virtual resources, and nurse-led navigation. Six potential implementation barriers related to limited confidence among nurses in facilitating cost of care conversations and conflicts between existing workflows and the intervention were identified. Conclusions: Guided by CFIR, we were able to identify contextual factors that may influence the implementation of the proposed virtual OFLN intervention. These findings will be used to further adapt our proposed OFLN intervention and implementation processes to facilitate seamless integration into health systems.