Abstract
BACKGROUND: Early-stage lung cancer mostly occurs asymptomatically and is found incidentally as peripheral pulmonary nodules on medical imaging. Cone beam CT-guided navigation bronchoscopy (CBCT-NB) is a novel and evidence-based minimally invasive procedure to obtain a tissue diagnosis from these pulmonary nodules. To clinically implement this innovation in practice, this study investigated barriers and facilitators to CBCT-NB implementation in a nationwide setting as observed in the Netherlands. METHODS: In-depth semistructured interviews and focus groups were conducted among healthcare professionals directly involved in the CBCT-NB implementation in hospitals nationwide. The updated Consolidated Framework for Implementation Research (CFIR) was used for creating the interview guide and structuring the analysis. RESULTS: 13 healthcare professionals spearheading implementation efforts across eight hospitals (three university, five non-university hospitals) were interviewed. A total of 52 facilitators and 38 barriers were identified throughout all CFIR domains. Important facilitators to CBCT-NB implementation were patient safety, reimbursement availability, future demand, intrinsic motivation of local implementation leaders and regional network collaborations and coordination on implementation. Main barriers included financial constraints, uncertainty about the availability of important resources, the need for new and complex skills acquisition and the anticipated time needed for the entire implementation process. CONCLUSION: CBCT-NB is described as a highly valuable innovation within the field of diagnostic procedures for pulmonary nodules. Our findings reveal important barriers and facilitators to CBCT-NB implementation. Understanding these factors is crucial for developing and optimising implementation strategies to achieve successful implementation of innovative minimally invasive image-guided procedures like CBCT-NB in a nationwide setting.