Why Do Evidence-Based Treatments Fail to Reach Children and Young People? An Exploration of the Critical Determinants of Photobiomodulation Implementation in the UK and Ireland

Background

Oral mucositis is a common and debilitating side effect of childhood cancer and stem cell transplant treatments. It affects the quality of life of children and young people (CYP) and places a strain on services. Photobiomodulation is recommended for oral mucositis prevention in international guidance but is poorly implemented in UK Principal Treatment Centres (PTCs). Our study explored the key barriers and facilitators to implementing photobiomodulation into standard care.

Methods

CYP, their parents, and healthcare professionals (HCPs) were purposively sampled for diversity in theoretically important characteristics: stage of adoption of PTC, professional role (HCPs), age (CYP), and photobiomodulation modality. Initial deductive framework analysis on semi-structured interview data was guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative summaries were then inductively generated, articulating the valence of influence and effect. Overarching themes were developed and refined in collaboration with patient involvement groups.

Results

Twenty-seven participants were interviewed: 18 HCPs from 11 diverse PTCs, 1 industry representative, and 4 CYP/Parent dyads. Participants had experience with low-level laser (n = 15) and light-emitting diode (LED) (n = 13) systems. Perceived barriers and facilitators varied between PTCs, participant groups, and photobiomodulation systems. Five themes were developed: (1) framing photobiomodulation as essential to routine care in busy cancer services; (2) photobiomodulation as simple, proactive, and rewarding; (3) need for navigable, interconnected, multiprofessional networks to support implementation; (4) balancing individualisation of services with the need for guidance and standardisation; and (5) increasing implementation of LED systems, with fewer barriers, over time.

Conclusion

Implementing photobiomodulation in paediatric oncology depends less on its clinical evidence and more on the local conditions that enable reliable delivery. This study highlights the importance of aligning service structures, workforce capacity, and professional networks to ‘embed’ photobiomodulation as routine care. Theory-informed implementation strategies can reduce current inequities in access and provide a transferable model for introducing other evidence-based supportive care interventions.