Effectiveness of guideline dissemination and implementation strategies on health care professionals’ behaviour and patient outcomes in the cancer care context: a systematic review

Abstract

Background: Health care professionals (HCPs) use clinical practice guidelines (CPGs) to make evidence-informed decisions regarding patient care. Although a large number of cancer-related CPGs exist, it is unknown which CPG dissemination and implementation strategies are effective for improving HCP behaviour and patient outcomes in a cancer care context. This review aimed to determine the effectiveness of CPG dissemination and/or implementation strategies among HCPs in a cancer care context. Methods: A comprehensive search of five electronic databases was conducted. Studies were limited to the dissemination and/or implementation of a CPG targeting both medical and/or allied HCPs in cancer care. Two reviewers independently coded strategies using the Mazza taxonomy, extracted study findings, and assessed study quality. Results: The search strategy identified 33 studies targeting medical and/or allied HCPs. Across the 33 studies, 23 of a possible 49 strategies in the Mazza taxonomy were used, with a mean number of 3.25 (SD = 1.45) strategies per intervention. The number of strategies used per intervention was not associated with positive outcomes. Educational strategies (n = 24), feedback on guideline compliance (n = 11), and providing reminders (n = 10) were the most utilized strategies. When used independently, providing reminders and feedback on CPG compliance corresponded with positive significant changes in outcomes. Further, when used as part of multi-strategy interventions, group education and organizational strategies (e.g. creation of an implementation team) corresponded with positive significant changes in outcomes. Conclusions: Future CPG dissemination and implementation interventions for cancer care HCPs may benefit from utilizing the identified strategies. Research in this area should aim for better alignment between study objectives, intervention design, and evaluation measures, and should seek to incorporate theory in intervention design, so that behavioural antecedents are considered and measured; doing so would enhance the field's understanding of the causal mechanisms by which interventions lead, or do not lead, to changes in outcomes at all levels.

Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review

“…Few studies used financial or organizational approaches, whereas no study used regulatory approaches. This finding was also observed in other reviews [ 29 ]. Thus, future studies should investigate the unused approaches, which may be effective for improving CPG dissemination and implementation.…”

“…In other words, the perspectives of other healthcare practitioners on barriers to the utilization of CPGs are less understood. This point was observed in similar reviews [ 29 ]. Patient-centered care requires multidisciplinary expertise.…”

Even High-Quality CPGs Seldom Include Implementation Strategies

“…The implementation strategies most frequently found among the high-quality CPGs were at the professional level, consisting mainly of the distribution of reference material, individual and group education of healthcare professionals, and presentation of CPG material at meetings. This is consistent with reports in previous studies ( Pantoja et al, 2017 ; Tomasone et al, 2020 ). Clinical algorithms, CPG versions directed at physicians, and material for classes, and presentations on CPGs were commonly found at the professional level.…”

Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed‐Methods Study Using an Interrupted Time Series Approach

“…The training of healthcare professionals, a strategy that is commonly utilized in the implementation of a CPG (Gagliardi & Alhabib, 2015), was repeated throughout the present implementation process, resulting in high percentages of healthcare professionals who became adequately trained, a factor that is positively associated with the increase in BF rates at hospitals (Tomasone et al, 2020). On the other hand, the indicators related to the users showed important changes directed at supporting and empowering the mothers who breastfed their children after delivery.…”

“…In the past few years, the implementation of clinical practice guidelines (CPGs) has increased in the health services as a systematic strategy that improves healthcare and patient outcomes (Hulscher & Wensing, 2020; Shekelle, Woolf, Grimshaw, Schünemann, & Eccles, 2012). A review of the literature on the implementation of CPGs showed that in the past decade, the studies have preferentially examined the implementation of CPGs dealing with chronic processes (high blood pressure, diabetes, pain, stroke, chronic obstructive pulmonary disease, cancer; Etxeberria et al, 2018; Friesen‐Storms et al, 2018; McCarter et al, 2018; Pons, Foks, Dippel, & Hunink, 2019; Shores et al, 2018; Tomasone, Kauffeldt, Chaudhary, & Brouwers, 2020). The strategies utilized were many, but the results were inconsistent, partly because the studies used strategies with very few components, the implementation of theoretical frameworks were not utilized, or an adequate evaluation of barriers was not performed (Gagliardi & Alhabib, 2015).…”