Factors influencing physicians’ decision to conduct cardiovascular risk assessments among cancer patients: A Systematic Review

Abstract

Background Improved cancer survivorship has led to untoward effects of developing cardiovascular complications, mainly due to exposure to cardiotoxic cancer therapy. Cardiovascular screening can provide substantial benefits to patient care and outcomes, but successful implementation is challenging. This systematic review consolidates factors from existing literature and explores its relationships to highlight key domains that need to be addressed to implement these risk assessment programs in clinical practice. Methods We searched PubMed, EMBASE, CINAHL, Web of Science and PsycINFO using search terms focused specifically on factors influencing the implementation of cardiovascular risk assessment among the cancer population. Two reviewers completed independently in study selection, data extraction, and quality assessment. To get meaningful insight of the findings, we thematically matched those factors into the domain of the Tailored Implementation for Chronic Diseases (TICD) framework and inductively identified its relationships. Results Twelve studies met the inclusion criteria. Identified factors were grouped into six domains, of which the top three included factors related to individual health professionals, which were cited in 83% of studies, incentives and resources (75% of the studies), and professional interactions in 58% of studies. Within the domain of individual health professional, we include factors concerning cognitions and attitudes, knowledge and skills, and professional behaviour. The domain of incentives and resources highlighted the needs for availability of necessary resources, continuing education system, assistance for clinicians and financial-related issues. Communication influence, team and referral processes were found to be the main barriers in the domain of professional interaction. Bi-directional associations were evident between these domains, which were categorised into macro and micro levels for better interpretation. Conclusion This review identified key factors that could be leveraged to improve cardiovascular assessment reach and appeal. Future intervention efforts should first be targeted at the level of healthcare professionals, who are the key drivers of the entire process.