Facilitators and barriers to clinical practice guideline-consistent supportive care at pediatric oncology institutions: a Children’s Oncology Group study

Abstract

Background Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions. Methods Healthcare professionals at 26 pediatric, Children's Oncology Group-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. Supportive care CPG implementation facilitators and barriers were solicited using nominal group technique (NGT), and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from an analysis of NGT items were identified, first from each focus group and then across all focus groups. Results Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were organizational factors including charging teams with CPG implementation, individual factors including willingness to standardize care, user needs and values including mentorship, system factors including implementation structure, and implementation strategies including a basis in science. The top five barriers of CPG implementation identified were organizational factors including tolerance for inconsistencies, individual factors including lack of trust, system factors including administrative hurdles, user needs and values including lack of inclusivity, and professional including knowledge gaps. Conclusions Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs, and eliminate implementation barriers. Trial registration ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016.

Symptom management care pathway adaptation process and specific adaptation decisions

“…There may be challenges to care pathway implementation [ 24 – 29 ]. We included an interprofessional review stage in our procedures to facilitate implementation.…”

Children's Oncology Group 2023 blueprint: Nursing discipline

“…COG nurses also conduct and lead research in collaboration with other COG disease and domain committees and investigators, including CCL, 53,54 YI, 55 outcomes/survivorship, 56 adolescent/young adult (AYA), 57 ALL, 52,58–60 myeloid leukemia, 61 neuroblastoma, 62 and central nervous system tumor 63,64 committees.…”

Children's Oncology Group 2023 blueprint for research: Cancer care delivery research

“…We learned that healthcare professionals at NCORP institutions who care for pediatric patients believe that their institution plays a critical role in facilitating clinical practice guideline‐consistent care. For example, they believed that their institution is responsible for cultivating strong relationships between stakeholders, allocating resources required to initiate and sustain practice‐level change, and promoting a culture where evidence‐based practice and care delivery standardization are valued 9 . Healthcare professionals at NCORP institutions also informed that they wanted (i) the opportunity to understand the rationale behind clinical practice guideline recommendations, and (ii) the clinical practice guideline‐consistent choices to be both obvious and readily accessible.…”