The implementation process of a return to work intervention in German cancer counseling centers

Abstract Background The second most common cause of death in Germany is cancer, and new cases are expected to increase by over 20% by 2045. About 35% of patients are of working age at diagnosis. Returning to work (RTW) is crucial for individuals, promoting social participation and security. Amidst demographic changes and labor shortages, also the society benefits from cancer patients’ RTW. However, only up to 74% of cancer patients return, indicating problems in the process. Outpatient cancer counseling centers (OCCs) provide free psychosocial and social law support for patients. An intensified counseling intervention was developed to assist cancer patients in RTW, and this study aims to examine the factors that facilitate or hinder its implementation. Methods The CARES feasibility study used a sequential, quasi-experimental pre-post design. The counseling intervention was piloted in 18 OCCs. The formative evaluation included semi-structured interviews with 16 clients in the intervention group and 11 counselors. The interview guides and the data analysis were based on the Consolidated Framework for Implementation Research (CFIR). In the content analysis, deductive codes according to the CFIR were supplemented inductively. This study presents results for the implementation process domain. Results The counseling professionals were intrinsically motivated to participate and willing to help clients. Also, they were motivated by the financial support through the study. However, additional required efforts and labor shortages hindered implementation. Overall, the clients’ willingness to participate facilitated the implementation, but difficulties during enrolment and usage of some intervention parts occurred. Conclusions Counseling professionals and clients’ motivation facilitated implementation. The changeable barriers can be adapted in future implementation processes of the counseling intervention, e.g. during the follow-up project QV-CARES. Key messages • The present results of the formative evaluation provide first evidence of the feasibility and acceptability of the intervention. • Changeable barriers for implementation can be adapted in future implementation processes of the counseling intervention.