Improving adherence to lung cancer guidelines: a quality improvement project that uses chart review, audit and feedback approach

Abstract

IntroductionThe implementation of evidence-based clinical practice guidelines is one of the most effective interventions for improving quality of care. A gap between guidelines and clinical practice often exists, which may result in patients not receiving appropriate care. This project aimed at improving adherence to lung cancer guidelines at our institution.MethodThe records of patients with lung cancer were evaluated for adherence to guidelines by using an auditing tool that was developed to capture pertinent information. The study team collected data about the following variables: compliance with documentation of pathological diagnosis, documentation of disease stage prior to treatment initiation, presentation at thoracic tumour board within 30 days of diagnosis, management course, and management of end of life in terms of early ‘no code’ initiation, stopping chemotherapy and referral to palliative care prior to 2 weeks of death. Annual audits were performed from 2012 to 2015. Education and discussion with team members to address the deviations were the main interventions to improve adherence.ResultsThe baseline measurements were taken in 2012 (49 patients). Histological subtype identification improved from 94% to 100%. Presentation of new cases at the tumour board improved from 35% to 82%. Testing for epidermal growth factor receptor mutation for non-squamous cell lung cancer improved from 77% to 100%. The staging was documented in 100% of the cases.ConclusionRunning audits to monitor adherence to guidelines and discussions with the team have a positive effect on providing consistent evidence-based care for patients with lung cancer.

Optimizing lung cancer MDT data for maximum clinical impact—a scoping literature review

“…National lung cancer audits such as in the UK above, Denmark (44) and the Netherlands (16,45) demonstrate the effects of systems that include institutional data feeds into national registries, portals for feedback and subsequent benchmarking. Smaller scale studies have tested details of audit and feedback to clinicians both in lung cancer (43,46) and other fields (47) but there is little if any (to our knowledge) literature on the effects of real-time, clinical data feedback to lung cancer MDTs on clinical outcomes. Cancer outcomes data are often delayed, even in this series of papers with an average of over four years between the data collection period and publication of the paper.…”

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

“…Particularly, MDTs are of paramount importance in the management of cancer patients. It has been well-documented that MDTs improve the outcomes for such patients [ 2 ], likely due to engagement of different specialties in a consensus and evidence-based exercise. Several studies reviewing overall performance within the meetings have resulted in various tools being developed to standardise the assessment of MDTs.…”

“…Whilst guideline resources are valuable, it is important to recognise that these are not prescriptive nor comprehensive and that variation might be necessary based on logistic and clinical factors. Adherence to guidelines based on outcome recommendations by MDTs is a topic that has been extensively investigated [ 2 , 7 , 8 , 9 ]. Obviously, adherence to guidelines alone does not necessarily indicate a successful MDT process; it does, though, represent an attempt to standardise the process, reduce errors, and monitor variation in practices [ 2 ].…”

“…Adherence to guidelines based on outcome recommendations by MDTs is a topic that has been extensively investigated [ 2 , 7 , 8 , 9 ]. Obviously, adherence to guidelines alone does not necessarily indicate a successful MDT process; it does, though, represent an attempt to standardise the process, reduce errors, and monitor variation in practices [ 2 ].…”

“…There are many factors which can affect the MDT decision-making process, including the membership, the quality of radiology and pathology resources, time restraints, and the availability of all the relevant clinical information [ 2 , 4 , 7 , 8 ]. It has been shown that, in patients with unifocal papillary thyroid cancer (PTC), pathologic and radiological intra- and inter-observer variability can greatly impact the MDT recommendations [ 10 ].…”