School of Kinesiology & Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada.
Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
Implement Sci. 2020 Jun 3;15(1):41. doi: 10.1186/s13012-020-0971-6.
Health care professionals (HCPs) use clinical practice guidelines (CPGs) to make evidence-informed decisions regarding patient care. Although a large number of cancer-related CPGs exist, it is unknown which CPG dissemination and implementation strategies are effective for improving HCP behaviour and patient outcomes in a cancer care context. This review aimed to determine the effectiveness of CPG dissemination and/or implementation strategies among HCPs in a cancer care context.
A comprehensive search of five electronic databases was conducted. Studies were limited to the dissemination and/or implementation of a CPG targeting both medical and/or allied HCPs in cancer care. Two reviewers independently coded strategies using the Mazza taxonomy, extracted study findings, and assessed study quality.
The search strategy identified 33 studies targeting medical and/or allied HCPs. Across the 33 studies, 23 of a possible 49 strategies in the Mazza taxonomy were used, with a mean number of 3.25 (SD = 1.45) strategies per intervention. The number of strategies used per intervention was not associated with positive outcomes. Educational strategies (n = 24), feedback on guideline compliance (n = 11), and providing reminders (n = 10) were the most utilized strategies. When used independently, providing reminders and feedback on CPG compliance corresponded with positive significant changes in outcomes. Further, when used as part of multi-strategy interventions, group education and organizational strategies (e.g. creation of an implementation team) corresponded with positive significant changes in outcomes.
Future CPG dissemination and implementation interventions for cancer care HCPs may benefit from utilizing the identified strategies. Research in this area should aim for better alignment between study objectives, intervention design, and evaluation measures, and should seek to incorporate theory in intervention design, so that behavioural antecedents are considered and measured; doing so would enhance the field's understanding of the causal mechanisms by which interventions lead, or do not lead, to changes in outcomes at all levels.
医疗保健专业人员（HCPs）使用临床实践指南（CPGs）就患者护理做出基于证据的决策。尽管存在大量与癌症相关的 CPG，但尚不清楚在癌症护理环境中，哪些 CPG 传播和实施策略对于改善 HCP 行为和患者结局最为有效。本综述旨在确定在癌症护理环境中针对医疗保健专业人员传播和/或实施 CPG 的策略的有效性。
对五个电子数据库进行了全面检索。研究仅限于针对癌症护理中的医疗和/或辅助 HCP 传播和/或实施 CPG。两名审查员独立使用 Mazza 分类法对策略进行编码，提取研究结果，并评估研究质量。
搜索策略确定了 33 项针对医疗和/或辅助 HCP 的研究。在这 33 项研究中，Mazza 分类法中共有 49 项策略中的 23 项得到了应用，每项干预措施平均使用 3.25 项（SD=1.45）。干预措施中使用的策略数量与阳性结果无关。教育策略（n=24）、对指南依从性的反馈（n=11）和提供提醒（n=10）是最常用的策略。单独使用时，提供提醒和对 CPG 依从性的反馈与结果的显著正向变化相对应。此外，当作为多策略干预的一部分使用时，小组教育和组织策略（例如创建实施团队）与结果的显著正向变化相对应。
未来针对癌症护理 HCP 的 CPG 传播和实施干预措施可能受益于使用已确定的策略。该领域的研究应旨在更好地协调研究目标、干预设计和评估措施之间的关系，并应寻求在干预设计中纳入理论，以便考虑和衡量行为前因；这样做将增强该领域对干预如何导致或不导致各级结果发生变化的因果机制的理解。
