Implementation determinants of a multi-center financial navigation program: A qualitative analysis of technical assistance and peer support calls.

328 Background: The Lessening the Impact of Financial Toxicity (LIFT) intervention—a financial navigation intervention—demonstrated superior preliminary effectiveness to most financial hardship interventions. However, scaling LIFT to an eight-site single-arm trial posed implementation challenges that were not present in the single-site pilot study. Methods: We used a deductive-inductive hybrid qualitative approach to analyze transcribed meeting recordings from N = 55 technical assistance (TA) and N = 23 peer support (PS) calls with financial navigators from each site. First, we deductively coded all implementation-relevant content into the five domains (i.e. outer setting, inner setting, individuals, process, and innovation) of the Consolidated Framework for Implementation Research (CFIR). We then inductively generated themes and sub-themes within each of the CFIR domains. Coder reliability was assessed at multiple points during coding via coder consensus. Results: The qualitative analysis of nearly 78 hours of TA and PS calls with financial navigators resulted in 19 themes and 91 sub-themes across the six CFIR domains. Within the outer setting (7 themes, 46 sub-themes), key determinants were institutional hiring freezes, scarce organizational resources for specific needs (e.g., housing), the unpredictability of external resource application success. Key determinants in the inner setting (3 themes, 15 sub-themes) were the use of existing clinical infrastructure (e.g., support groups, uninsured list) and navigators’ competing responsibilities in the clinic. Key determinants in individuals (2 themes, 11 sub-themes) were the navigator workload and the patient motivation to engage in LIFT. The key determinant in innovation (2 themes, 5 sub-themes) was the intervention structure. The most common implementation determinants in the process (i.e., implementation strategies; 4 themes, 23 sub-themes) were pacing intervention content to meet patient needs, reframing the study to appeal to specific patient needs, and changing the delivery mode of the intervention (e.g., phone during COVID). Conclusions: Financial navigation for cancer survivors is a resource intensive interventional approach to minimizing financial toxicity. While highly effective, there are implementation barriers at all levels of CFIR that impede the scalability of financial navigation that must be addressed. Clinical trial information: NCT04931251 .