A Multisite Qualitative Analysis of Barriers and Facilitators to Adopting Tenecteplase

INTRODUCTION: Tenecteplase (TNK) is an emerging treatment for acute ischemic stroke (AIS) being adopted in place of alteplase (ALT). Compared to ALT, TNK has a longer half-life, shorter administration time, lower cost, and similarly high efficacy in treating large vessel occlusion. Nevertheless, there are barriers to TNK adoption as a treatment for AIS.

OBJECTIVES: The objective of this study is to identify thematic barriers and facilitators to TNK implementation at hospitals within the state of Texas.

MATERIALS & METHODS: This qualitative research study uses a phenomenological approach with hermeneutic cycling. After initial question development, subsequent questions were identified during each hermeneutic cycle in preparation for the next interview. Using purposive sampling, we interviewed stroke coordinators and physicians associated with the Lone Star Stroke Research Consortium, a statewide research network in Texas. The consortium is comprised of participants from 6 hub hospitals and 28 spoke hospitals including both community-based facilities to Comprehensive Stroke Centers. Interviews lasting 20-40 minutes were recorded and transcribed verbatim. Transcribed material was dissected and grouped into cohesive themes. Each stage of thematic analysis required consensus from the research team to proceed to the next interview. Sampling ended when saturation was reached.

RESULTS: Saturation was reached after four interviews. Three themes and eight sub-themes were identified. The theme Evidence had three sub-themes: Pro-Con Balance, Fundamental Knowledge, and Pharmacotherapeutics. The theme Process flow had four sub-themes: Proactive, Reflective self-doubt, Change Process Barriers, and Parameter Barriers. The theme Consensus had one sub-theme: Getting Buy-In.

CONCLUSION: Through qualitative interviewing, we identified themes and sub-themes in an effort to understand barriers and facilitators faced by hospitals when transitioning from ALT to TNK. The next study will use implementation science techniques and will involve designing an implementation toolkit informed by the data from this study. It is anticipated that this toolkit will be used in a prospective interventional block randomized study.