Implementing blended cognitive behavioral therapy for severe fatigue in routine hospital care for diffuse glioma patients: a qualitative study

Abstract Background: Severe fatigue is common in diffuse glioma patients and can persist after tumor treatment. Fatigue-tailored blended cognitive behavioral therapy (bCBT) has been shown to reduce severe fatigue in glioma patients. This study aimed to identify barriers and facilitators to implementing bCBT for severe fatigue in glioma care and to develop implementation strategies tailored to the neuro-oncology context. Methods: A qualitative study was conducted among healthcare professionals involved in glioma care, including neurologists, nurse practitioners, and (neuro)psychologists. Semi-structured interviews were conducted with a topic list guided by the Consolidated Framework for Implementation Research. Data were analyzed using a combined deductive and inductive approach. Implementation strategies were developed by integrating identified barriers and facilitators, participant suggestions, and research team expertise. Results: Twenty-six healthcare professionals from several Dutch neuro-oncological centers participated in this study. Key themes of implementation included the perceived need for fatigue treatment with bCBT, referral to psychological care, knowledge on patient eligibility for bCBT, awareness of fatigue and bCBT, confidence in its evidence, capacity constraints, digital platform access and financial responsibility. Implementation strategies were tailored to identified barriers across three phases: identifying fatigue, referring diffuse glioma patients and treating severe fatigue with bCBT. Conclusions: Implementation of bCBT for severe fatigue in glioma care requires more than evidence of effectiveness. Successful integration into routine hospital care will depend on timely fatigue identification, clear referral responsibilities, appropriate patient selection, trained professionals and alignment with local organizational and financial conditions. Center-specific implementation strategies may facilitate integration of bCBT into neuro-oncology care.