Qiwei Feng, Zixin Wei, Xi Luo, Qin Zhou, Yufeng Liu, Zihan Liu, Qiuling Shi, Juan Li
Among 892 respondents, 7.3% were very familiar with CGA and 77.8% had never received CGA-related training. Department-level full implementation was 2.5%, and only 1.5% met a stricter composite full-implementation threshold requiring advanced familiarity and formal training. Implementation was significantly associated with CGA familiarity, prior training (P < 0.001), and clinical specialty (P = 0.002). Cascade analysis identified major losses at the familiarity-to-practice and training-to-implementation transitions, while confidence and perceived meaningfulness were largely retained among respondents who crossed practice thresholds. The most common survey-reported barriers were time and tool complexity (65.9%) and poor patient compliance or completion (64.6%). Interviews identified three themes: tension between clinical pragmatism and standardized tools, context-driven adaptation of assessment, and systemic barriers to CGA implementation, including absent assessment-to-intervention pathways, fragmented teamwork, and insufficient electronic medical record support.
INTRODUCTION: Comprehensive geriatric assessment (CGA) is recommended to support individualized care for older adults with cancer, yet its uptake in Chinese oncology practice remains insufficiently characterized. We aimed to describe CGA familiarity, training, implementation, and barriers among Chinese oncology physicians and to explain adoption constraints in high-volume settings.
MATERIALS AND METHODS: We conducted an explanatory sequential mixed-methods study (QUAN→qual) from February 2024 to March 2025. Phase One was a network-based survey of oncology physicians across 29 provinces, assessing CGA familiarity, training, implementation, assessment content, and barriers; chi-square tests assessed factors associated with implementation, and a descriptive cascade analysis localized uptake attrition. Phase Two comprised interviews with 16 senior physicians (15 oncologists and 1 geriatrician) from four provinces, analyzed using Braun and Clarke's thematic analysis.
RESULTS: Among 892 respondents, 7.3% were very familiar with CGA and 77.8% had never received CGA-related training. Department-level full implementation was 2.5%, and only 1.5% met a stricter composite full-implementation threshold requiring advanced familiarity and formal training. Implementation was significantly associated with CGA familiarity, prior training (P < 0.001), and clinical specialty (P = 0.002). Cascade analysis identified major losses at the familiarity-to-practice and training-to-implementation transitions, while confidence and perceived meaningfulness were largely retained among respondents who crossed practice thresholds. The most common survey-reported barriers were time and tool complexity (65.9%) and poor patient compliance or completion (64.6%). Interviews identified three themes: tension between clinical pragmatism and standardized tools, context-driven adaptation of assessment, and systemic barriers to CGA implementation, including absent assessment-to-intervention pathways, fragmented teamwork, and insufficient electronic medical record support.
DISCUSSION: Stalled CGA uptake in Chinese oncology practice reflects a structural misfit between comprehensive assessment models and high-throughput, resource-constrained clinical workflows. A pragmatic, resource-stratified minimum viable pathway combining streamlined oncology-relevant assessments, explicit trigger points, task-sharing, and embedded informatics may provide a feasible direction for future implementation, pending validation in prospective, co-designed studies.