Abstract PO1-03-01: Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention
Authors: Martinez-Palacios Daniela , Cruz-Ramos Marlid , Fajardo-Espinoza Fernanda Sarahi , Rodriguez-Fonseca Yanira Elvira , Gonzalez-Perez Alicia , Barranco-Cortés Aline , Pérez-Camargo Dana Aline , Mohar Alejandro , Garza Cynthia Mayté Villarreal 
Published: May 2024

Abstract
Background. Breast cancer is the leading cause of cancer-related death and disability among young women in Mexico. The physical and psychological symptoms they experience affect their quality of life, physical functioning, and psychological well-being. To address this, the National Cancer Institute in Mexico City developed a program called "Joven & Fuerte" that provides services for young women with breast cancer. Due to the COVID-19 pandemic, the program has migrated to virtual attention and now offers hybrid attention to meet the needs of these patients. The research group developed the "Joven, Fuerte & Saludable" intervention, which is a hybrid (face-to-face and virtual) multidisciplinary lifestyle intervention that includes nutrition, rehabilitation, psychological support, mindfulness intervention, and lifestyle education for early disease young women undergoing oncology treatments. This study aims to evaluate the barriers and facilitators for implementing this lifestyle intervention. Methodology. The study involved young women with early breast cancer enrolled in the "Joven & Fuerte" program in 2022. They were invited to participate in a study to evaluate the barriers, facilitators, and challenges of a hybrid multidisciplinary lifestyle intervention during the first months since the diagnosis (3 months). The intervention included face-to-face consultations for anthropometric and biochemical assessments, interdisciplinary team evaluations, and virtual support through WhatsApp and Zoom. Educational materials such as printed or digital healthy lifestyle guides and educational videos were available on a private Facebook and YouTube group. Follow-up sessions were conducted via phone, video, or on-site visits. To evaluate lifestyle habits and quality of life status, distress, anxiety, and depression validated questionnaires were used. The CFIR and RE-AIM questionnaires were used to identify the barriers and facilitators among the program staff and patients while adopting the intervention. Results. The study found that patients were satisfied with the intervention and educational materials, but there were some barriers for implementation. One of the main barriers was the patients' geographical location, as 62.5% of patients were foreign and lived far from the hospital. Additionally, patients only sometimes used the educational materials due to forgetfulness, lack of time, not having internet access, or low digital literacy. Patients also had difficulty recognizing the impact of a "healthy lifestyle" and prioritized other consultations before the program schedule. Institutional barriers included a lack of human resources, which led to a loss in follow-up and patient motivation due to waiting-list periods. Undergraduate and postgraduate training students were introduced to support the multidisciplinary team in overcoming this challenge. Despite these obstacles, patients reported feeling supported by the multidisciplinary team and experienced benefits such as reduced stress and anxiety and better management of treatment side effects upon completing program activities. An important institutional success was achieved by reducing service waiting times from three months to just 1-2 weeks for all services. Conclusions. Cultural behavior and emotional distress at diagnosis and during the first 3 months of intervention are the major challenges for patients. A hybrid educational intervention seems convenient to make follow-up more practical and accessible. Patients feel motivated because they are in touch with their clinicians and receive fast resolutions to their concerns. Many talented and enthusiastic human resources are needed to implement these interventions, but it is possible for a Latin American public hospital, considering the essential benefits for the patients.
Citation Format: Daniela Martinez-Palacios, Marlid Cruz-Ramos, Fernanda Sarahi Fajardo-Espinoza, Yanira Elvira Rodriguez-Fonseca, Alicia Gonzalez-Perez, Aline Barranco-Cortés, Dana Aline Pérez-Camargo, Alejandro Mohar, Cynthia Mayté Villarreal Garza. Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-01.