Implementing guidelines to prevent cancer associated thrombosis: how can we do better?

Venous thromboembolism prevention in cancer care: implementation strategies to address underuse

“…We included stakeholders from different practice settings to elucidate more comprehensive barriers and facilitators, although, within a single health care setting, we found many strategies to be similar for community-based and academic-based oncology clinics. In addition, the barriers and facilitators experienced in our health system are similar to those reported by the University of Vermont [ 14 ]. However, the community-based oncologists in our study wanted to follow academics’ uptake rather than leading, which led to the implementation strategy of staged scale-up, first implemented in academic settings and then in community-based settings.…”

“…The framework also supported the identification of outcomes beyond the effectiveness of VTE prevention to include implementation and system outcomes achievable through the use of the strategies. Given the known challenges in moving evidence-based recommendations into clinical practice [ 23 , 24 ] and those emerging from dedicated work specifically in this area [ 13 , 14 ], intentional, directed development of comprehensive implementation strategies is essential to closing this gap. Using this implementation framework, we show multilevel strategies that are critical to addressing the contextual barriers to using evidence-based interventions for VTE prevention in the oncology setting.…”

“…Currently, few studies have addressed the gap between guideline recommendations and the lack of evidence-based interventions used for VTE prevention in oncology practice [ 14 ]. The University of Vermont implemented a successful quality-improvement initiative to increase VTE prevention interventions in ambulatory oncology; the cornerstones of the program were an electronic health record-based risk assessment tool, patient education on VTE, and referrals to thrombosis specialists for anticoagulation discussion [ 12 ].…”

“…In this study, in order to bridge the gap between guideline recommendations for VTE prevention interventions and their use in oncology practice, we used implementation science frameworks to select strategies to systematically address the barriers and leverage facilitators previously identified by stakeholder participants [ 14 ]. Implementation science provides methodology designed to facilitate broader and consistent uptake of evidence-based interventions found to be effective in clinical studies.…”

Implementation of a cancer-associated thrombosis prevention program at a rural cancer center

“…CAT prevention in community cancer centers with a predominately rural population has not been well studied [ 8 , 9 ]. A successful model for guideline implementation (the Vermont model) was based in an academic setting [ 9 ].…”