Fracture risk assessment in men with prostate cancer requiring long-term androgen deprivation therapy: a systematic scoping review using the i-PARIHS implementation framework

Abstract

Purpose Androgen deprivation therapy (ADT) is a mainstay of treatment of prostate cancer (PCa) and is associated with increased risk of osteoporosis and fragility fractures. Despite international guidelines to mitigate fracture risk, osteoporosis is under-diagnosed and under-treated due to poor implementation. This scoping review aims to synthesise knowledge surrounding the implementation of guidelines and strategies to inform health service interventions to reduce fracture risk in men with PCa taking ADT. Method Four databases and additional literature were searched from January 2000 to January 2023. Studies which provided evidence influencing the implementation of guidelines were included. The i-PARIHS (Promoting Action on Research Implementation in Health Services) framework was used to inform the narrative synthesis. Results Of the 1229 studies identified, 9 studies met the inclusion criteria. Overall, an improvement in fracture risk assessment was observed across heterogeneous study designs and outcome measures. Six studies were from Canadian. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilised an implementation framework. Barriers included lack of knowledge for both patients and clinicians, time constraints, unsupportive organisational structures and challenges in transferring patient care from specialists to primary care. Effective strategies included education, novel care pathways using a multidisciplinary approach and incorporating existing services, point-of-care interventions, and bespoke clinics. Conclusion Guideline implementation requires contextualisation and innovation to address barriers and enablers. Implications for Cancer Survivors Whilst specialist cancer care is expected, primary care clinicians can play an important role in management of complications from long-term cancer treatment induced bone loss. Futurestudies should incorporate both patient and clinician perspectives and co-design interventions in primary care.