The effectiveness of clinical guideline implementation strategies in oncology: a systematic review

Abstract

Importance: Guideline recommendations do not necessarily translate into changes in clinical practice behaviour or better patient outcomes. Objective: This systematic review aims to identify recent clinical guideline implementation strategies in oncology and to determine their effect primarily on patientrelevant outcomes and secondarily on healthcare professionals' adherence. Evidence Review: A systematic search of five electronic databases (PubMed, Web of Science, GIN, CENTRAL, CINAHL) was conducted between August and September 2021. Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence outcomes (screening, referral, prescribing, attitudes, knowledge) in the oncological setting, were targeted. The Cochrane risk-of-bias tool and the ROBINS-I tool were used for assessing the risk of bias. Certainty of evidence was evaluated according to GRADE recommendations. Findings: Of 1058 records identified, six studies, two stepped-wedge cluster RCTs and four controlled before-and after studies, were included in the narrative synthesis. All six studies assess the effect of multi-component interventions in 2024 cancer patients and 281 healthcare professionals. None of the included studies reported overall survival and adverse events. Compared to no intervention, educational meetings combined with materials, opinion leaders, audit and feedback, and a tailored intervention or academic detailing may slightly increase referral rates. Still, the certainty in this evidence is low. The effect of multi-component interventions compared to no intervention on the quality of life of cancer patients and screening rates, prescribing behaviour, attitudes, and knowledge of healthcare professionals is very uncertain. Conclusions and Relevance: Knowledge and skill accumulation through team-oriented or online educational training and dissemination of materials embedded in multi-component interventions seem to be the most frequently researched guideline implementation strategies in the last years in oncology. This systematic review cannot conclude which implementation strategy or combination of strategies is most effective, still, it gives an overview of recent strategies used for guideline implementation in oncology and can inform policymakers, professional organisations, and institutions on the development and adoption of implementation strategies.