Patient heterogeneity in the implementation of a supportive oncology care model: a longitudinal type-building qualitative content analysis

Background: Implementing supportive care models in oncology depends on patient engagement, and understanding heterogeneity in patients’ needs, awareness and access is crucial for optimising reach, acceptability and appropriateness in outpatient oncology. This analysis aimed to develop a longitudinal patient typology within the implementation of the OnCoPaTh supportive care model, which combines structured patient coaching with early palliative care integration, and to examine the typology’s contribution to understanding such implementation processes. Methods: This secondary analysis examined longitudinal qualitative data from patients with advanced cancer in German outpatient oncology. Patients were intervention-group participants in the OnCoPaTh cluster-randomised controlled trial, an initial implementation study. Semi-structured interviews with a purposeful sample were conducted at three time points approximately six months apart. Data were analysed using stepwise type-building qualitative content analysis (QCA) comprising structuring, evaluative and type-building steps. Results: Altogether, 37 interviews from 16 patients were analysed, including 30 from 10 with complete longitudinal follow-up. Four patient types were identified across these patient-time-point observations: (1) the needy – the prototype, who engaged actively and reported support from the OncoCoach; (2) the satisfied, who had access to the intervention but perceived no need for additional support; (3) the correctly unreached, whose low perceived needs made non-engagement appropriate; (4) the falsely unreached – missed opportunity, who indicated unmet needs yet reported little or no awareness of, or engagement with, the OncoCoaching component. Half of the patients with complete follow-up remained in the same type over time and the remainder transitioned as their well-being, care needs, awareness and preferences evolved. Early palliative care featured only marginally in patients’ accounts across all types, reflecting entrenched negative associations and, reportedly, limited introduction of the component. Conclusions: Type-building QCA captures patient heterogeneity in supportive oncology care implementation, illuminating variation in reach, acceptability and appropriateness that aggregate analyses obscure. The typology points to missed opportunities among falsely unreached patients and to the importance of intervention visibility, proactive communication and individually tailored delivery. Non-reach therefore cannot be read as implementation failure without a joint judgement about appropriateness. Trial registration: DRKS00023255 (German Clinical Trials Register), retrospectively registered on 5 November 2020.