Adherence to an oncology clinical practice guideline

Higdon, Cynthia (2018) Adherence to an oncology clinical practice guideline. Practicum Report. Memorial University of Newfoundland. (Unpublished)

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Abstract

Background and Purpose: In 2014, a multidisciplinary breast cancer group developed and disseminated a clinical practice guideline to assist surgeons in choosing eligible patients, with locally advanced or inflammatory breast cancer, for whom a referral should be sent to medical oncology for consideration of neoadjuvant treatment. However, it was unclear whether surgeons had been adhering to this guideline. The purpose of this practicum was to compare the neoadjuvant referral rates pre- and post-guideline dissemination and evaluate the effects of patient/tumor/facility-related factors on surgeons’ decision to refer. Methods: (1) literature review; (2) consultation with key stakeholders; (3) chart review; and (4) recommendations. Results: The factors of interest and methods were informed by the literature review and the consultations. During the chart review process, data were collected on 47 and 54 patient cases from 2013 (pre-guideline) and from 2016 (post-guideline), respectively. All patient cases of inflammatory breast cancer were referred for both study years. In contrast, the referral rates for all cases of locally advanced breast cancer was 23.3% and 26.9%. In 2016, patients were more likely to be referred if they had positive lymph node involvement, AJCC stages of IIIA and IIIC, triple negative subtypes, or received definitive surgery at university-affiliated hospitals. Conclusion: There has been little to no improvement for guideline adherence between the study years and the referral rates for eligible patients were poor. Future efforts to clarify the guideline and improve referral appear to be warranted.

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