Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Eur J Public Health. 2017 Aug 1;27(4):616-620. doi: 10.1093/eurpub/ckw234.
Guideline adherence remains a challenge in clinical practice, despite guidelines' ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and cancer-specific guideline characteristics on adherence.
Based on data from a national cancer registry, adherence was evaluated for 15 treatment recommendations for breast, colorectal, prostate and lung cancer, and melanoma. Recommendations were selected by representatives of the medical specialist associations responsible for developing and implementing the guidelines. We used multivariable multilevel analysis to calculate mean adherence and variation between individual hospitals.
Mean adherence to the different treatment recommendations ranged from 40 to 99%. Adherence differed only slightly between older and newer guidelines and between recommendations with low, moderate or high levels of evidence (range 79-84% and 77-91%, respectively), while adherence differed more between recommendations for different cancer types (range 54-99%), different treatment modalities (adherence ranged from 40 to 92%) or recommendations that advised against or recommended in favour of particular treatment (adherence ranged from 75 to 98%).
We found significant variation in adherence between different cancer treatment guidelines. While some guideline characteristics that seem to explain this variation may be considered difficult to modify, the potential for variance across cancer types and treatment modalities suggests that adherence could be further improved. At the same time, these results warrant tailored strategies for the improvement of adherence to clinical practice guidelines.
尽管指南具有改善患者预后的潜力，但在临床实践中，遵循指南仍然是一个挑战。我们研究了荷兰国家癌症治疗指南推荐的遵循程度，以及一般和癌症特异性指南特征对遵循程度的影响。
基于国家癌症登记处的数据，我们评估了针对乳腺癌、结直肠癌、前列腺癌和肺癌以及黑色素瘤的 15 项治疗建议的遵循情况。建议由负责制定和实施指南的医学专家协会代表选择。我们使用多变量多层次分析来计算个体医院之间的平均遵循程度和差异。
不同治疗建议的平均遵循程度在 40%至 99%之间。旧指南和新指南之间以及证据水平低、中或高的建议之间的遵循程度差异仅略有不同（分别为 79-84%和 77-91%），而不同癌症类型（54-99%）、不同治疗方式（遵循程度为 40-92%）或建议反对或赞成特定治疗（遵循程度为 75-98%）之间的建议之间的遵循程度差异更大。
我们发现不同癌症治疗指南之间的遵循程度存在显著差异。虽然一些似乎可以解释这种差异的指南特征可能难以修改，但癌症类型和治疗方式之间的差异表明可以进一步提高遵循程度。同时，这些结果需要制定有针对性的策略来提高临床实践指南的遵循程度。
