Niño de Guzmán Ena, Song Yang, Alonso-Coello Pablo, Canelo-Aybar Carlos, Neamtiu Luciana, Parmelli Elena, Pérez-Bracchiglione Javier, Rabassa Montserrat, Rigau David, Parkinson Zuleika Saz, Solà Iván, Vásquez-Mejía Adrián, Ricci-Cabello Ignacio
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Breast Cancer Res Treat. 2020 Jun;181(3):499-518. doi: 10.1007/s10549-020-05657-8. Epub 2020 May 6.
Clinical guidelines' (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers' adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers' adherence.
We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics.
Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8-67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68-77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10-80%), for the follow-up, to 90% (IQR 87-92.5%) for ET. Internal factors that potentially impact on healthcare providers' adherence were their perceptions, preferences, lack of knowledge, or intentional decisions.
A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers' adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones.
PROSPERO (CRD42018092884).
遵循临床指南有助于提供高质量医疗服务。然而，医疗服务提供者并非总是遵守临床指南的建议。本系统文献综述旨在评估欧洲医疗服务提供者对乳腺癌临床指南的遵循程度，并确定影响医疗服务提供者遵循指南的因素。
我们检索了截至2019年5月MEDLINE和Embase数据库中的系统综述以及定量或定性的原始研究。由一位作者进行纳入标准评估、数据提取和偏倚风险评估，并由另一位作者进行交叉核对。我们进行了叙述性综合分析，关注医疗过程的模式、衡量遵循程度的方法、临床指南的范围以及人群特征。
在8137篇参考文献中，我们纳入了在八个欧洲国家开展的41项原始研究。大多数研究采用回顾性队列设计（19/41；46%），且偏倚风险较低或中等。乳腺癌整体医疗过程（从诊断到随访）的遵循率在54%至69%之间；整体治疗过程[包括手术、化疗（CT）、内分泌治疗（ET）和放疗（RT）]的中位遵循率为57.5%（四分位间距（IQR）38.8 - 67.3%），而全身治疗（CT和ET）的遵循率为76%（IQR 68 - 77%）。单独评估各过程的中位遵循率更高，随访的遵循率为74%（IQR 10 - 80%），ET的遵循率为90%（IQR 87 - 92.5%）。可能影响医疗服务提供者遵循指南的内部因素包括他们的认知、偏好、知识缺乏或故意决策。
相当一部分乳腺癌患者未接受临床指南推荐的治疗。欧洲医疗服务提供者对乳腺癌临床指南的遵循情况在几乎所有医疗过程中都有改进空间。临床指南的制定和实施过程应解决影响医疗服务提供者遵循指南的主要因素，尤其是与患者相关的因素。
PROSPERO（CRD42018092884）
