Preventing venous thromboembolism for ambulatory patients with cancer: Developing the form and content of implementation strategies

Background For ambulatory cancer patients receiving systemic chemotherapy, adherence is low to recommended venous thromboembolism (VTE) prevention interventions. Previously, we identified implementation strategies to address barriers to adherence, including (1) conducting clinician education and training; (2) developing and distributing educational materials for clinicians; (3) adapting electronic health records to provide interactive assistance; and (4) developing and distributing educational materials for patients. The objective of this study was to develop these implementation strategies’ form (i.e., how and when) and content (i.e., information conveyed) as a critical step for implementation and dissemination. Methods To design and develop the form and content of the implementation strategies, we conducted multidisciplinary stakeholder panels with oncology clinicians, pharmacists, and hematologists. Over several panel discussions, we developed a low fidelity prototype. Participants performed preliminary usability testing, simulating patient care encounters. We also conducted interviews with three patients who provided additional feedback. Results The form and content for each strategy, respectively, included 1) concise training with a slide deck; 2) succinct summary of evidence for the interventions and support for anticoagulation management; 3) automated VTE risk-assessment and clinical decision support, including bleeding risk assessment and anticoagulation options; and 4) patient education resources. During development, audit and feedback was identified as an additional strategy, for which we created report cards to implement. Conclusion With stakeholder input, we successfully developed the form and content needed to put the implementation strategies into practice. The next step is to study the effect on the uptake of ambulatory VTE prevention recommendations in oncology clinics.