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Challenges in Clinical Trial Implementation: Results from a Survey of the National Accreditation Program of Breast Centers (NAPBC)

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although the results of clinical trials often guide best practices, changing clinical practice based on clinical trial results can be challenging. The objective of this study was to examine provider-reported barriers to adopting best clinical practices according to clinical trial data.

Methods

A cross-sectional survey was conducted of providers from the National Accreditation Program for Breast Centers about barriers that prevent the incorporation of trial findings. Descriptive analyses and multivariable analyses were performed to determine provider characteristics that were significantly associated with reported barriers.

Results

Overall, 383 institutions participated (63.5% response rate), with a total of 1226 physicians responding to the survey (80% response rate). Providers identified national guidelines and meetings as the most compelling way to receive practice-changing information. They reported the following internal barriers to trial implementation: patient preference (45%), strongly held beliefs by partners/colleagues (37%), and insufficient time to discuss new practices (30%). External barriers preventing trial implementation included a lack of agreement from multidisciplinary tumor boards (32%), fear of reimbursement loss (23%), and resistance from clinical staff (20%). Reported barriers differed by provider specialty, with plastic surgeons and radiation oncologists reporting that strongly held beliefs by partners/colleagues and disagreement from multidisciplinary tumor boards were the most significant factors preventing clinical trial implementation.

Conclusions

Physician beliefs and patient preferences are the most frequently reported barriers to clinical trial implementation. Tactics to better educate providers about how to explain new clinical trial data to their patients and colleagues are needed.

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References

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–1230.

    Article  Google Scholar 

  2. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289(15):1969–1975.

    Article  Google Scholar 

  3. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform 2000;1:65–70.

    Google Scholar 

  4. Alliance for Clinical Trials in Oncology. https://www.allianceforclinicaltrialsinoncology.org/main/. Accessed 20 Nov 2018.

  5. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–226.

    Article  Google Scholar 

  6. Hull L, Athanasiou T, Russ S. Implementation science: a neglected opportunity to accelerate improvements in the safety and quality of surgical care. Ann Surg 2017;265(6):1104–1112.

    Article  Google Scholar 

  7. Caudle AS, Hunt KK, Tucker SL, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144–3151.

    Article  Google Scholar 

  8. Weiss A, Mittendorf EA, DeSnyder SM, et al. Expanding implementation of ACOSOG Z0011 in surgeon practice. Clin Breast Cancer 2017;13(17):30412–30413.

    Google Scholar 

  9. Caudle AS, Bedrosian I, Milton DR, et al. Use of sentinel lymph node dissection after neoadjuvant chemotherapy in patients with node-positive breast cancer at diagnosis: practice patterns of American Society of Breast Surgeons Members. Ann Surg Oncol. 2017;24(10):2925–2934.

    Article  Google Scholar 

  10. FACS Overview of Cancer Programs. https://www.facs.org/quality-programs/cancer/quality. Accessed 20 Nov 2018.

  11. National Comprehensive Cancer Network, Incorporated. https://www.nccn.org/patients/guidelines/stage_0_breast/. Accessed 28 Mar 2017.

  12. Morrow M, Abrahamse P, Hofer TP, et al. Trends in reoperation after initial lumpectomy for breast cancer: addressing overtreatment in surgical management. JAMA Oncol. 2017;3(10):1352–1357.

    Article  Google Scholar 

  13. Rosenberger LH, Mamtani A, Fuzesi S, et al. Early Adoption of the SSO-ASTRO Consensus Guidelines on margins for breast-conserving surgery with whole-breast irradiation in Stage I and II invasive breast cancer: initial experience from Memorial Sloan Kettering Cancer Center. Ann Surg Oncol. 2016;23(10):3239–3246.

    Article  Google Scholar 

  14. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717–730.

    Article  Google Scholar 

  15. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32(14):1507–1515.

    Article  Google Scholar 

  16. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol. 2016;23(12):3801–3810.

    Article  Google Scholar 

  17. Rycroft-Malone J, Seers K, Crichton N, et al. A pragmatic cluster randomised trial evaluating three implementation interventions. Implement Sci. 2012;7:80.

    Article  Google Scholar 

  18. Foster TJ, Bouchard-Fortier A, Olivotto IA, Quan ML. Effect of multidisciplinary case conferences on physician decision making: breast diagnostic rounds. Cureus. 2016;8(11):e895.

    PubMed  PubMed Central  Google Scholar 

  19. Litjens RJ, Oude Rengerink K, Danhof NA, Kruitwagen RF, Mol BW. Does recruitment for multicenter clinical trials improve dissemination and timely implementation of their results? A survey study from the Netherlands. Clin Trials. 2013;10(6):915–923.

    Article  Google Scholar 

  20. Lenfant C. Shattuck lecture—clinical research to clinical practice—lost in translation? N Engl J Med. 2003;349(9):868–874.

    Article  Google Scholar 

  21. Petrelli NJ. A community cancer center program: getting to the next level. J Am Coll Surg. 2010;210(3):261–270.

    Article  Google Scholar 

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Disclosures

Nicole Lopez reports a fellowship grant from the National Library of Medicine (Grant No. 5T15LM011271-07). Kelly Hunt reports institutional research funding from Lumicell and Endomag, and medical advisory board roles at Armada Health and Merck & Co. Anna Weiss, Erin P. Ward, Katherine C. Lee, Abigail S. Caudle, Diana Dickson-Witmer, Cecilia Chang, Kaitlyn Kelly, Linda Williams Martin, Lisa Kay Jacobs, Katherine Yao, and Sarah L. Blair have nothing to disclose.

Funding

This work was supported by the ACS CRP and a donation from the Chicago Platform Tennis Charities.

Author information

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA

    Anna Weiss MD

  2. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Anna Weiss MD

  3. Department of Surgery, University of California – San Diego, San Diego, CA, USA

    Nicole E. Lopez MD, Erin P. Ward MD, Katherine C. Lee MD, Kaitlyn Kelly MD & Sarah L. Blair MD

  4. Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Abigail S. Caudle MD & Kelly K. Hunt MD

  5. Department of Surgery, Helen F. Graham Cancer Center and Research Institute, Newark, DE, USA

    Diana Dickson-Witmer MD

  6. Department of Surgery, NorthShore University Health System, Evanston, IL, USA

    Cecilia Chang MS & Katherine Yao MD

  7. Department of Thoracic Surgery, University of Virginia, Charlottesville, VA, USA

    Linda Williams Martin MD, MPH

  8. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Lisa Kay Jacobs MD

Authors
  1. Anna Weiss MD
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  2. Nicole E. Lopez MD
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  3. Erin P. Ward MD
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  4. Katherine C. Lee MD
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  5. Abigail S. Caudle MD
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  6. Diana Dickson-Witmer MD
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  7. Cecilia Chang MS
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  8. Kaitlyn Kelly MD
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  9. Linda Williams Martin MD, MPH
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  10. Lisa Kay Jacobs MD
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  11. Kelly K. Hunt MD
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  12. Katherine Yao MD
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  13. Sarah L. Blair MD
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Corresponding author

Correspondence to Anna Weiss MD.

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Weiss, A., Lopez, N.E., Ward, E.P. et al. Challenges in Clinical Trial Implementation: Results from a Survey of the National Accreditation Program of Breast Centers (NAPBC). Ann Surg Oncol 26, 4364–4371 (2019). https://doi.org/10.1245/s10434-019-07807-9

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  • DOI: https://doi.org/10.1245/s10434-019-07807-9

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