Designing for delivery: a Delphi study of feasibility-informed implementation strategies for a fear of cancer recurrence clinical pathway

Abstract Purpose Fear of cancer recurrence (FCR) is pervasive among cancer survivors, yet evidence-based care is rarely implemented. Clinical pathways offer a structured approach to translating evidence into practice. This study identified key implementation barriers, enablers, and strategies for feasibly integrating an FCR clinical pathway comprising screening, assessment, and triage to stepped care into practice. Methods A three-round Delphi study was conducted with Australian health professionals and FCR researchers. Participants rated and provided qualitative feedback on the feasibility of FCR clinical pathway elements. Qualitative responses were content analysed using the updated Consolidated Framework for Implementation Research. Recommended strategies were mapped using the Expert Recommendations for Implementing Change taxonomy. Results Eighty-nine participants completed Round 1, 69 Round 2, and 73 Round 3. Feasibility ratings varied across pathway elements (49–90%). Stepped care elements were widely endorsed as feasible (71-83% agreement), while resource-intensive recommendations (e.g., training all staff for screening) were perceived as least feasible. Key implementation enablers included Adaptability, Access to Knowledge and Information, and strong Innovation Recipient Need. Major barriers were Available Resources, Work Infrastructure and limited Innovation Deliverer Opportunity. Recommended strategies included tailoring delivery to local contexts and patient needs supported by modular training and local champions. Conclusion Implementing the FCR clinical pathway requires pragmatic adaptation and system-level support. Prioritising high-impact elements, providing training, integration into existing workflows, and shared decision-making to meet patient needs are critical. Future research should evaluate these strategies using hybrid effectiveness–implementation designs to ensure sustainable implementation and improved patient outcomes.