The Development of an Intervention to Enhance the Adoption of Hematopoietic Cell Transplant Survivorship Care Plans Using Implementation Science.

Allogeneic hematopoietic stem cell transplant (HCT) recipients are at risk for late complications that can impact their quality of life. While guidelines for follow-up care exist, survivors often do not receive or adhere to them. A survivorship care plan (SCP) can help by providing patients with tailored information on diagnosis, treatment, and screening recommendations. The Center for International Blood and Marrow Transplant Research (CIBMTR) developed an HCT-SCP that is auto-populated with patients' clinical data. Although the HCT-SCP showed positive results in a randomized clinical trial, it is not used by transplant centers (TCs). The purpose of this study is to design an intervention using implementation science (IS) that facilitates HCT-SCP use at TCs.

The study uses the Behavior Change Wheel (BCW) as a framework for intervention design. Barriers to implementation of the HCT-SCP were ideated and mapped to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Using the BCW, the study team generated interventions aligned with the components of COM-B, and prioritized solutions based on estimated impact and feasibility. Behavior change techniques (BCT) were used to build comprehensive strategies to facilitate HCT-SCP adoption at six TCs.

Sixty-five barriers to HCT-SCP use were identified. Forty-three potential interventions were identified under six BCW intervention functions that mapped to 15 BCTs including goals and planning, feedback and monitoring, social support, shaping knowledge, natural consequences, comparison of behavior, associations, comparison of outcomes, and antecedents. Evaluation is underway to determine TC staff experience implementing the HCT-SCP. Preliminary data analysis indicates that 80% (N=71) of eligible patients received the HCT-SCP.

This study highlights the significance of using implementation science to facilitate the adoption of HCT-SCPs in TCs. Context-specific approaches were used to identify barriers and develop an intervention with positive preliminary results toward HCT-SCP distribution. Increasing the adoption of HCT-SCPs is critical because they can bridge the gap in post-HCT care, enhancing care continuity and quality.