Nurses' perspectives on perioperative pulmonary rehabilitation for patients with lung cancer in the pre-implementation phase: a CFIR 2.0-guided study.

Background: Despite strong evidence supporting perioperative pulmonary rehabilitation (PR) for patients undergoing lung cancer surgery, little is known about factors that may influence implementation prior to program rollout, particularly in resource-constrained settings. Guided by the updated Consolidated Framework for Implementation Research (CFIR 2.0), this study aimed to identify anticipated barriers and facilitators to inform program refinement and future implementation strategies. Methods: A descriptive qualitative design was used. Semi-structured interviews were conducted with nurses from the thoracic surgery department of a tertiary hospital in China (September-November 2025). Guided by the four CFIR 2.0 domains (innovation, outer setting, inner setting, individuals), directed content analysis was performed based on nurses' perspectives. Results: Sixteen nurses were interviewed, representing diverse roles: Ward/ICU frontline staff nurses, charge nurses, unit secretaries, administrative nurses and nurse managers. Relevant constructs included 22 of the 29 CFIR 2.0 constructs and 8 subconstructs. Facilitators spanned: innovation (source, evidence base, relative advantage, trialability); outer setting (financing, policy, external pressure); inner setting (relational connections, communication, culture, incentive systems); and individual factors (team needs, leadership/practitioner capability, motivation). Barriers comprised: innovation (adaptability, complexity, cost); outer setting (local condition, partnerships and connections); inner setting (structural characteristics, compatibility, access to knowledge and information); and individuals (recipient needs, capability). Notably, implementation concerns differed across nursing roles, reflecting role heterogeneity and underscoring the need for tailored implementation strategies. Conclusion: Implementation of perioperative PR for patients undergoing lung cancer surgery is influenced by multilevel factors spanning innovation, outer setting, inner setting, and individuals determinants. Differences in concerns across nursing roles highlight the importance of role-tailored implementation strategies. These findings provide a foundation for optimizing implementation approaches and may facilitate the sustainable integration of evidence-based PR into routine practice, particularly in resource-constrained healthcare settings.