Implementation strategies preferred by primary care clinicians to facilitate cancer prevention and control activities

Introduction: Key stakeholders need to be involved in the identification of feasible and impactful implementation strategies for evidence-based interventions. While a wide range of implementation strategies has been developed, there is little research on their applicability when addressing different cancer prevention and control (CPC) efforts in primary care.Methods: With an emphasis on rural practices, we conducted a survey of primary care physicians to identify implementation strategies they perceive as most feasible and impactful. The survey included both primary prevention behavior change counseling and cancer screening issues. Analyses contrasted ratings of feasibility and impact across these activities and nine implementation strategies, and among clinicians in different settings with a focus on comparisons between clinicians in rural vs. non-rural settings.Results: We had 326 respondents from a wide range of practice types, representing four different practice-based research networks, 49 states, and including 177 clinicians in rural settings. Ratings of impact were somewhat higher than those for feasibility. Few of the nine implementation strategies were high on both impact and feasibility. Only ‘adapting to my practice’ was rated higher than a 4 (“moderate”) on both impact and feasibility. There were relatively few differences between rural and non-rural clinicians or associated with other clinician or setting characteristics.Conclusions: There is considerable variability in perceived impact and feasibility of implementation strategies for CPC activities among primary care clinicians. It is important to assess both feasibility and impact of implementation strategies as well as their generalizability across settings. Our results suggest that optimal strategies to implement evidence-based CPC activities will likely need to be developed or adapted for primary care settings. Future research is needed to replicate these findings with different settings and interventions, and identify practical, stakeholder informed implementation strategies.