Applying the multiphase optimisation strategy to develop and optimise implementation strategies for promoting clinicians' implementation of hepatocellular carcinoma surveillance: a study protocol.

Abstract

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide, posing a significant public health burden. Early diagnosis and effective treatment options are crucial for improving the curative effect and quality of life of patients. However, the detection of early-stage HCC remains challenging due to its strong compensatory function. HCC surveillance is an evidence-based practice with sufficient evidence. Numerous studies have demonstrated that HCC surveillance effectively increases early diagnosis rates and improves survival rates among liver cancer patients. Yet, its utilisation in clinical practice remains limited, at approximately 24%. Given the pivotal role clinicians play in HCC surveillance, their implementation barriers are more likely to lead to underutilisation of surveillance. This study aims to identify the barriers to implementing HCC surveillance guidelines among clinicians, subsequently developing and optimising efficient implementation strategies to enhance adherence to these guidelines. This study will be carried out at hospitals within the Yunnan Infectious Diseases Specialist Alliance. Focusing on promoting clinicians' implementation of HCC surveillance, the study pursues two objectives: (1) Under the guidance of the Consolidated Framework for Implementation Research, semistructured interviews and a literature review will be conducted to analyse the barriers clinicians face in implementing HCC surveillance guidelines; (2) Employing the preparation and optimisation phase of the Multiphase Optimisation Strategy framework, effective implementation strategies will be developed and optimised to enhance clinicians' implementation of HCC surveillance. The primary outcome measure is fidelity, assessed through rigorous patient-reported data collection methods. Statistical analyses will include independent samples t-tests, χ² tests, Wilcoxon rank sum tests and multiple logistic regression analyses, performed using R V.4.4.1. The statistical significance level will be set at 0.05. This study has been approved by the Ethics Committee of the Kunming Third People's Hospital (KSLL20230711005). Participants will provide informed consent before taking part in the study. Results will be published in peer-reviewed journals in open-access formats, and anonymised data will be made available. ChiCTR2300071570.