Implementation of a tool to identify social vulnerability in the cancer care pathway: the iDEFCO study (Preprint)

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BACKGROUND The cancer care pathway can cause or accentuate inequalities. It is therefore necessary to identify patients with such social vulnerabilities as early as possible and take them into account throughout the treatment process. The DEFCO (Detection of Social Frailty and Cancer Patient Care Pathway Coordination) tool has been created by a public health research team and industrial engineering research team and has previously shown its validity. The transferability and possibilities of implementation in other structures of this tool, developed in a specialized institution, must now be proven. It is also necessary to evaluate it in terms of impact on the fluidity of care paths and on the social impacts of the disease. OBJECTIVE The objective is to assess the implementation of the DEFCO tool for identifying social vulnerability in new centers. METHODS This is a multicenter prospective cohort implementation study using a mixed-methods effectiveness-implementation design to evaluate a complex intervention. This study will be conducted in five sequential stages. First, the organizational contexts of each participating center and their capacity to implement the DEFCO tool will be assessed. Second, key stakeholders will be trained to integrate the DEFCO tool into routine clinical practice. Third, a pre-implementation analysis will be carried out using the Consolidated Framework for Implementation Research (CFIR) to identify contextual determinants influencing implementation. Fourth, the DEFCO tool will be deployed in each center. Finally, the implementation process and outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (Re-AIM) framework for quantitative measures, complemented by qualitative assessments guided by the CFIR. RESULTS The results of this implementation study will provide information on: 1) the effectiveness in real life of the DEFCO tool, the objective of which is to identify social vulnerability in new cancer patients; 2) the impact of the modifications made to the initial tool to adapt to the contexts and the differences in practice according to the populations being cared for and therapeutic practice; 3) the key success factors and the pitfalls to be avoided, interacting with the effectiveness of the tool, 4) the modifications in the representations of social vulnerability and its consequences brought about by the implementation of the tool. CONCLUSIONS Thanks to the implementation study, the generalization of this tool will be accompanied by instructions for use and the contextual elements necessary for optimal operation of the systematic detection of social vulnerability in the care pathway of patients treated for cancer in health care institutions of varying status and activity. CLINICALTRIAL NCT04015895

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