Table 1 Identified implementation factors for the early application of high-dose chemotherapy with autologous stem cell rescue in the Netherlands as mentioned by at least half of the respondents within at least one stakeholder group
Themes and implementation factors | Categories | Healthcare professionals (n = 11a) | Patients and patientrep (n = 5) | Policy-makers (n = 4) | Researchers (n = 3) | Importance criteriad | |
|---|---|---|---|---|---|---|---|
No | Theme: Patient-related factors | Nb | N | N | N | Value | |
1 | Clear information provision necessary for this complex treatment via leaflets, visual aids and/or websites | Provision of information | 8c | 3 | 2 | 1 | B, C |
2 | A negative sentiment of high-dose chemotherapy due to the history of the treatment | Treatment perception | 6 | 1 | 0 | 3 | A, B |
3 | Sharing of treatment experiences between patients and treating medical oncologists | Treatment perception | 2 | 4 | 0 | 0 | B |
Theme: Organizational factors | |||||||
4 | The use of a pathology alert systems other alerts to create awareness of ongoing trials | Identification of patients | 7 | 1 | 0 | 1 | A, B, C |
5 | Multidisciplinary team meetings with (all) regional hospitals to increase inclusion rates | Identification of patients | 8 | 0 | 1 | 0 | B |
6 | Educate (referring) medical oncologists about the treatment, trial, eligibility criteria and prognoses | Referral of patients | 3 | 3 | 0 | 1 | B |
7 | Clear communication, responsibilities, and cooperation between and within departments (i.e., medical oncology, haematology, radiology, surgery, nurses, quality managers & hospital pharmacy) | Organization of HDCT | 8 | 0 | 1 | 0 | A, B |
8 | One dedicated professional, and specialized “buddy system” in supportive care | Supportive care | 4 | 3 | 0 | 0 | B, C |
9 | Optimal timing, necessity and duration of supportive care for this treatment is unknown | Supportive care | 6 | 1 | 0 | 1 | B, C |
10 | Patients would benefit from oncologic physical therapy | Supportive care | 5 | 3 | 0 | 0 | B |
11 | Centralize HDCT for quality purposes (i.e. use of accreditation, guidelines, & quality managers) | Nationwide organization | 8 | 1 | 2 | 1 | A, B, C |
12 | BRCA1-like test can be performed in all centres if acquainted with MLPA | Nationwide organization | 7 | 0 | 0 | 0 | A, C |
13 | Experience on ASCT in the treating centre is required | Education | 7 | 0 | 0 | 1 | A, B, C |
14 | The specific capacity for ASCT like the amount of apheresis equipment, beds, and trained personnel are important | Capacity | 2 | 0 | 2 | 0 | A, B |
Theme: Clinical factors | |||||||
15 | Attention for short- and long-term effects: | ||||||
-Effect of HDCT on cardiovascular diseases (e.g., dyslipidemia, arrhythmia, high blood pressure) | Side-effects and adverse events | 3 | 3 | 1 | 0 | A, B, C | |
-Effect of HDCT on fertility | 6 | 1 | 1 | 0 | |||
-Effect of HDCT on cognition (e.g. concentration problems, chemobrain, etc.) | 8 | 5 | 0 | 1 | |||
-Effect of HDCT on patient functioning (e.g. effect on work, relationships, etc.) | 6 | 4 | 2 | 0 | |||
-Effect of HDCT on psychological problems (e.g. trauma, depression, anxiety etc.) | 6 | 1 | 1 | 1 | |||
16 | Overall survival is most important for patients | Effectivity of the treatment | 5 | 3 | 3 | 1 | A, B, C |
17 | Quality of life after the treatment should also be taken into consideration | Effectivity of the treatment | 6 | 3 | 2 | 0 | A, B, C |
18 | A high toxicity, intense treatment is acceptable when prognosis significantly improves | Intensity of the treatment | 7 | 1 | 0 | 1 | A, B, C |
Theme: Study-related factors | |||||||
19 | Randomization might withhold patients from participating with the SUBITO study | SUBITO study | 6 | 0 | 1 | 0 | B, C |
20 | Additional publications on high-dose chemotherapy help with treatment acceptance among healthcare providers | SUBITO study | 8 | 1 | 3 | 2 | A, C |