基于个体药物水平测量的个性化剂量并相应地调整剂量可以提高疗效并减少肿瘤治疗不必要的毒性。然而，对于伊马替尼、舒尼替尼和帕唑帕尼，这种治疗药物监测 (TDM) 指导的剂量并未常规使用，尽管越来越多的证据支持个体化剂量。因此，我们的目的是确定和量化 TDM 指导下的伊马替尼、舒尼替尼和帕唑帕尼给药的（潜在）障碍和促进因素。我们在所有利益相关者中进行了一项混合方法研究：患者、医疗保健专业人员 (HCP)、制药公司和健康保险公司。在本研究的第一个定性部分中，我们进行了半结构化个人访谈和一次焦点小组访谈，以识别所有（潜在）障碍和促进因素，在本研究的第二个定量部分中，我们使用基于网络的调查来量化这些发现。访谈涉及 Grol 和 Wensing 变革模型实施的六个领域：（1）创新本身； (2) HCP； (3) 患者； (4) 社会背景； (5) 组织背景； (6) 财务、法律和治理。在定性研究中，我们采访了 20 名患者、18 名 HCP 以及 10 名制药和健康保险公司的代表，并确定了 72 个障碍和 90 个促进因素。在定量研究中，66 名 HCP 和 58 名患者对调查做出了回应。重要的障碍在于 HCP 领域，例如缺乏 TDM 经验 (36.4%)、患者领域，例如缺乏 TDM 意识 (39.7%)，以及测量和解释的处理时间TDM 结果 (40.9%)（组织领域）。重要的促进因素是对 HCP 的教育 (95.5%)、对患者的教育 (87.9%) 以及促进对何时何地进行 TDM 测量的概述 (86.4%)。我们确定并量化了实施 TDM 的重要障碍和促进因素伊马替尼、舒尼替尼和帕唑帕尼的指导剂量。根据我们的结果，实施策略应主要侧重于对 HCP 和患者进行教育以及 TDM 的组织方面。© 2023 作者。约翰·威利出版的癌症医学

Personalized dosing based on measurement of individual drug levels and adjusting the dose accordingly can improve efficacy and decrease unnecessary toxicity of oncological treatment. For imatinib, sunitinib, and pazopanib, this therapeutic drug monitoring (TDM)-guided dosing is, however, not routinely used, despite accumulating evidence favoring individualized dosing. Therefore, we aimed to identify and quantify (potential) barriers and facilitators in TDM-guided dosing for imatinib, sunitinib, and pazopanib.We performed a mixed methods study among all stakeholders involved: patients, healthcare professionals (HCPs), pharmaceutical companies, and health insurance companies. During the first qualitative part of this study, we performed semi-structured individual interviews and one focus group interview to identify all (potential) barriers and facilitators, and during the second quantitative part of this study, we used a web-based survey to quantify these findings. The interviews addressed the six domains of the implementation of change model of Grol and Wensing: (1) the innovation itself; (2) the HCP; (3) the patient; (4) social context; (5) organizational context; and (6) finances, law, and governance.In the qualitative study, we interviewed 20 patients, 18 HCPs and 10 representatives of pharmaceutical and health insurance companies and identified 72 barriers and 90 facilitators. In the quantitative study, the survey was responded by 66 HCPs and 58 patients. Important barriers were on the domain of the HCP, such as a lack of experience with TDM (36.4%), on the domain of the patient, such as lack of awareness of TDM (39.7%), and the processing time for measurement and interpretation of the TDM result (40.9%) (organizational domain). Important facilitators were education of HCPs (95.5%), education of patients (87.9%) and facilitating an overview of when and where TDM measurements are being performed (86.4%).We identified and quantified important barriers and facilitators for the implementation of TDM-guided dosing for imatinib, sunitinib, and pazopanib. Based on our results, the implementation strategy should mainly focus on educating both HCPs and patients and on the organizational aspect of TDM.© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.