Pre-implementation factors for Active Music Engagement (AME): barriers and facilitators to integrating an evidence-based dyadic intervention into pediatric oncology care.
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BACKGROUND: Pediatric cancer treatment is a difficult and distressing experience that often results in sustained, interrelated distress in young children and parents, and traumatic stress symptoms for some parents. Few evidence-based interventions address this dyadic distress. Active Music Engagement (AME) is a manualized, evidence-based music play intervention that significantly reduces distress in child/parent dyads and mitigates traumatic stress and improves well-being among highly distressed parents and those experiencing sociodemographic risk. Successfully integrating AME into standard care requires a systematic understanding of implementation factors. This study aimed to identify site-specific barriers and facilitators that influenced successful AME delivery during a recently completed randomized controlled trial, leveraging multidisciplinary team insights to inform the selection of implementation strategies needed to successfully integrate AME into standard care. METHODS: Semi-structured interviews (n = 10) were conducted with study personnel responsible for coordination and delivery of AME in a previous multisite randomized controlled trial; this included Advanced Practice Nurses and Board-Certified Music Therapists from our three participating sites. Interview questions were informed by the Consolidated Framework for Implementation Research. Data were analyzed using Rapid Qualitative Analysis and reported following the Planning for and Assessing Rigor in Rapid Qualitative Analysis framework. RESULTS: Findings highlighted that AME was strongly supported by staff with direct exposure to the intervention. Key barriers were primarily structural, including limited clinic space, competing demands in the outpatient setting, and limited awareness of the music therapy role among executive leadership. Key facilitators included the intervention's strong theoretical structure, the perceived high compatibility of AME principles with inpatient care needs, and the value of peer support/collaboration among music therapists. Participants recommended aligning AME delivery with existing inpatient infrastructure, enhancing referral and prioritization systems to manage demand, and refining therapist training to prioritize core theoretical constructs over manualized content. CONCLUSION: Future research and implementation efforts should focus on integrating AME into routine inpatient pediatric care, where service structure and patient/parent needs compatibility are highest. Strategies should include broader engagement with hospital leadership and parents, a clear plan for staffing/resource allocation, modified intervention training that supports flexible delivery, and the development of structured decision-support tools for targeted patient referral.