Implementing targeted thromboprophylaxis as a supportive care model: Mapping implementation preferences across the cancer care pathway.

Abstract

e13552 Background: Risk-directed supportive care models aim to target interventions to patients most likely to benefit, yet implementation in routine oncology practice is often limited by workflow complexity, unclear role delineation, and uncertainty in patient selection. Cancer-associated thromboembolism (TE) exemplifies this challenge, with guideline-recommended thromboprophylaxis for high-risk ambulatory patients inconsistently delivered. The Australian phase III TARGET-TP trial (ACTRN12618000811202) demonstrated that biomarker-directed thromboprophylaxis reduced TE and mortality. This study mapped implementation preferences and identified barriers and enablers to inform scalable risk-directed care. Methods: This qualitative implementation study used semi-structured focus groups with patients/carers (n = 14) and healthcare professionals (HCPs; n = 20) across six groups. Process mapping elicited preferred and alternative approaches to delivering thromboprophylaxis across the care pathway. Implementation preferences were specified using the AACTT framework (Action, Actor, Context, Target, Time) and compared between consumers and HCPs. Deductive analysis applied AACTT and the Theoretical Domains Framework (TDF). Results: Six core implementation actions (ordering, risk assessment, documentation, prescribing, supply, and education) were discussed with 33 participants. HCPs favoured oncologist-led risk assessment embedded within tumour-specific electronic order sets with active prompts, supported by allied health stewardship to oversee appropriateness, documentation, and continuity. Junior doctors were positioned as implementers when plans were pre-documented, reducing cognitive and workflow burden. Patients and carers expressed heterogeneous preferences for consent and communication, ranging from passive integration of risk testing into routine blood collection with notification only if action was required, to preference for upfront discussion emphasising purpose and a clear management plan. TDF mapping showed HCP barriers clustered in early workflow stages, driven by Memory, Attention and Decision Processes, Environmental Context and Resources, and Social/Professional Role and Identity. Patient barriers were fewer and centred on education and consent, primarily within Knowledge, Beliefs about Consequences, and Emotion. Across groups, treatment modality (injectable vs oral) influenced acceptability. Conclusions: AACTT and TDF identified role-specific, workflow-sensitive strategies to support delivery of risk-directed supportive care in routine oncology practice. These findings highlight transferable implementation principles aligning digital systems, workforce roles, and patient preferences, with potential to reduce missed opportunities for evidence-based thromboprophylaxis.