Preimplementation expectations and perceptions of a preoperative frailty screening and optimization intervention: A qualitative analysis.

BACKGROUND

Patients with frailty face greater postoperative mortality and adverse outcomes. However, evidence regarding interventions for mitigating the risks associated with frailty is lacking. The PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery trial is an ongoing stepped-wedge cluster randomized Hybrid Type-1 clinical effectiveness-implementation trial on frailty screening and multidisciplinary optimization in Veterans Affairs medical centers. We sought to identify systemic and individual-level factors influencing the implementation of the intervention in order to tailor it to local contexts and improve implementation. This qualitative analysis summarizes the findings of our preimplementation formative evaluation of the PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery trial.

METHODS

The trial implementation and analysis were determined by the Consolidated Framework of Implementation Research. We conducted individual interviews and focus groups with Veterans Affairs surgical chiefs and other stakeholder providers at 3 participating sites. Our analytic approach relied on team-based thematic analysis with a dual coding review (Krippendorf α = .92).

RESULTS

Among 28 interviews and 6 focus groups, innovation, setting, and implementation were the 3 most relevant Consolidated Framework of Implementation Research domains. Participants valued the multidisciplinary format and envisioned many positive impacts of the frailty screening and optimization intervention. However, concerns arose around the intervention's relative advantage over the current process and compatibility with current workflow, staffing, and resources. Participants made recommendations to address barriers, which varied by local context and specialty.

CONCLUSION

Although providers supported the PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery intervention and its purpose, local logistical barriers and site/specialty-specific contextual factors were identified through formative evaluation that would influence uptake of the intervention. Our study supports the use of a preimplementation formative evaluation to inform adaptations for complex trial designs.