Elijah Tyedmers

BackgroundThe ZERO Childhood Cancer Program is an Australian precision medicine initiative for young people (up to age 21 years) that enables personalised treatment recommendations. To facilitate access to recommended therapies, alongside paediatric oncology professionals, we co-designed ProCure – a novel online medicines access tool. The beta version includes searchable access profiles for targeted therapies (by name, drug class, molecular target, registration status and company), Drug Access Navigator support, and a clinician forum for sharing access experiences. This study aimed to (i) evaluate ProCure’s acceptability, appropriateness, and functionality; (ii) identify barriers and facilitators to implementation; and (iii) identify theory-informed implementation strategies to support national scale-up.MethodsTwelve purposively selected end-users (seven paediatric oncologists, three ZERO scientists, and two oncology pharmacists) involved in therapy recommendation and medicines access within ZERO undertook intensive beta testing of ProCure over 8–10 weeks before in-depth evaluation interviews. A mixed-methods design combined the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) with inductive qualitative content analysis and deductive analysis guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. Implementation strategies were identified by matching barriers to Expert Recommendations for Implementing Change strategies and Behaviour Change Techniques.FindingsProCure was rated acceptable (AIM mean=4.7/5) and appropriate (IAM mean=4.5/5). Participants valued its intuitive design, centralised access information, and potential to streamline compassionate access applications, while suggesting functionality refinements. Key barriers related to Innovation Design, Capability/Knowledge, and Motivation/Beliefs about Consequences. Facilitators outnumbered barriers (3:1). Constructs were organised into nine subcategories (e.g., Information Access and Usability). Candidate implementation strategies included Identify and Prepare Champions, Conduct Educational Meetings, and Develop Educational Materials alongside intuitive strategies (e.g., “super-users”).ConclusionProCure was an acceptable and appropriate tool for supporting medicines access in paediatric precision oncology. Beta testing informed refinement and identified factors likely to influence its national implementation.

Implementation science aims to bridge the gap between research evidence and routine healthcare practice by understanding and optimizing the integration of evidence-based interventions (EBIs). In this paper, we identify seven persistent challenges limiting implementation progress, including (1) overwhelming volume of implementation materials (e.g., reports, interviews, surveys), (2) contextual variability, (3) complex interactions among contextual factors, interventions, and outcomes, (4) stakeholder engagement constraints, (5) equity and access barriers, (6) insufficient or biased data, and (7) concerns around data security, trust, and ethics. We explore how advances in data science and artificial intelligence (AI) offer promising solutions to these challenges by enhancing evidence extraction and synthesis, contextual analysis, stakeholder engagement, and adaptation throughout the implementation process. Using a live project in precision oncology as a practical example, we demonstrate how AI tools, such as large language models (LLMs), clustering algorithms, and sentiment analysis, can support implementation research and practice, from concept (e.g., barriers, facilitators, strategies) extraction and barrier identification to process mapping. We also introduce ImpleMATE, an AI-enabled platform that integrates implementation science knowledge with dynamic learning health system workflows, enabling continuous knowledge extraction, decision support, and feedback for implementation improvement. While AI offers significant potential to accelerate and scale implementation efforts, we emphasize the need for ethical oversight, transparency, and human collaboration to ensure responsible, equitable, and impactful application in practice.

Introduction Genomic diagnostics have accelerated therapeutic and preventative breakthroughs in oncology and cancer genetics. Despite increased access, the implementation of genomics-based care faces serious fragmentation and scalability issues due to a lack of system support. The Precision Care Initiative aims to develop a novel and scalable Precision Care Clinic (PCC). It is designed to coordinate precision medicine in oncology and streamline decision support for referring oncologists and geneticists. The PCC will enhance quality of care through multifaceted, patient-centred communication. It will also improve translational capacity by integrating team expertise in precision oncology, implementation science, clinical informatics, cancer genetics, health economics and patient-reported measures. Methods and analysis This programme uses a type I and type II hybrid effectiveness-implementation trial design sequentially. The complex clinical intervention is precision oncology—matching the targeted treatment or risk management strategy to the right patient, based on their genomic, cancer staging, environmental, lifestyle and biological characteristics, etc. The service intervention is the PCC, providing centralised multidisciplinary review to facilitate shared decision-making with clinicians for the provision of optimal precision oncology care for their patients. The implementation intervention is the co-designed implementation platform—applying evidence-based implementation approaches and Learning Health System principles to enhance feasibility and sustainability. All adult patients across Australia referred to the PCC (n=est. 100–150/year), and healthcare professional interest holders involved in the delivery of precision oncology services, are eligible to participate. Over the study course, phase I involves using a mixed-methods approach to inform iterative co-design and pilot testing of the first PCC with an accompanying implementation platform, and a suite of outcome measures to assess effectiveness; phase II (hybrid type I) includes the implementation of the PCC and evaluation of the outcome measures designed in phase I; phase III (hybrid type II) involves a co-design of local adaptations and testing the effectiveness of the PCC model nationally. Ethics and dissemination The study received ethical approval from the St Vincent’s Hospital Human Research Ethics Committee (2023/ETH00373). Study results will be presented at relevant conferences and published in peer-reviewed journals. Trial registration number NCT06077110

Background: Hard-to-treat childhood cancers are those where standard treatment options do not exist and prognosis is poor. Healthcare professionals (HCPs) are responsible for communicating with families about prognosis and complex experimental treatment. We aimed to identify HCPs’ key challenges and skills required when communicating with families about hard-to-treat cancers, and their perceptions of communication-related training. Method: We interviewed Australian HCPs who had direct responsibilities in managing children/adolescents with a hard-to-treat cancer within the past 24 months. Interviews were analysed using qualitative content analysis. Results: We interviewed 10 oncologists, 7 nurses, and 3 social workers. HCPs identified several challenges for communication with families including: balancing information provision while maintaining realistic hope; managing their own uncertainty; and nurses and social workers being under-utilised during conversations with families, despite widespread preferences for multidisciplinary teamwork. HCPs perceived that making themselves available to families, empowering them to ask questions, and repeating information helped to establish and maintain trusting relationships with families. Half the HCPs reported receiving no formal training for communicating prognosis and treatment options with families of children with hard-to-treat cancers. Nurses, social workers, and junior oncologists supported the development of communication training resources, more so than senior oncologists. Conclusion(s): Resources are needed which support HCPs to communicate with families of children with hard-to-treat cancers. Such resources may be particularly beneficial for junior oncologists and other HCPs during their training, and should aim to prepare them for common challenges, and to foster greater multidisciplinary collaboration.