Clinicians’ attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature

Abstract

Background: Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs; however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence. Methods: A systematic search was undertaken of five databases; Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework. Results: The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs; (2) concern about the evidence underpinning CPGs; (3) clinician uncertainty and negative perceptions of CPGs; and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use; (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources; (7) awareness of CPGs and belief in their relevance; and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs.

Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program

“…We found similarities with the barriers that had previously been found in research studies related to the barriers to the implementation of CPGs, and more specifically to the implementation of the BFHI [ 10 , 11 , 12 , 14 ]. In a prominent manner, and above the other barriers at the level of the health organizational system context, the lack of human, physical and time resources was highlighted.…”

“…A systematic meta-review which included 25 systematic reviews published until 2017 [ 9 ] and three systematic reviews published posteriorly [ 10 , 11 , 12 ] underline as the main barriers the aspects related to: political and social context, such as lack of leadership and lack of coordination by the team; health organizational system context, such lack of staffing, and economic and time resources; clinical practice guideline context, such as recommendations that are not clear, and doubts about the quality of the evidence and rigidity; health professional context, such as lack of knowledge about the CPGs, negative attitude, and clinical inertia of practice and the belief that it is not part of one’s role; and patient context, such as lack of knowledge of the patients about the guidelines, the characteristics of the system and their illness, expectations that are contrary to the doctor’s, and lack of family support. The barriers highlighted in these systematic reviews are generally linked with the implementation of CPGs directed at interventions for the treatment of frequent pathologies and chronic diseases [ 10 , 11 , 12 ]. The studies on the implementation of CPGs of health promotion such as BF are less common, and have been mainly studied in environments of primary care and on aspects related to the prevention of chronic health problems and the implementation of practices related to lifestyle changes [ 13 ].…”

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

“…Barriers to recurrent miscarriage CPG implementation occur at four levels: the CPG; professionals; patients; and organizations (Van Den Boogaard et al, 2011). Several barriers and facilitators to CPG implementation have been documented (Francke et al, 2008) across a variety of areas, including cancer treatment (Bierbaum et al, 2020) and recurrent miscarriage (Van Den Boogaard et al, 2011). Barriers can include concern over CPG content and currency, concern about the evidence underpinning CPG (Gameiro et al, 2019;Bierbaum et al, 2020) and perceptions that the CPG is too complicated for use in practice (Gameiro et al, 2019).…”

Soft systems methodology for implementing clinical practice guidelines in a general hospital: a study protocol

“…The present ndings will be published with a focus on "understanding the context and complexity of the effective factors in implementing CPGs". The authors believe that adopting an attitude of inquiry and dynamically changing the diverse and numerous worldviews of professionals in the accommodation process, which is achieved using SSM, can help produce the knowledge that serves as a model for implementing CPGs for healthcare providers at the macro-system level [33]. In addition, the results of this study can be used at the hospital mesosystem level to facilitate the process of persuading to comply with CPGs and provide bene ts for professional healthcare providers.…”