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Barriers for the implementation of guidelines in palliative care—results from a national survey of professionals

Supportive Care in Cancer volume 26, pages 1943–1952 (2018)Cite this article

Abstract

Background

In 2015, an evidence- and consensus-based palliative care guideline in adults with incurable cancer was published by the German Guideline Program. Barriers and enablers for the guideline implementation of members of the German Association for Palliative Medicine (DGP) were unknown. Therefore, the aims of this study were (1) to evaluate professionals’ knowledge, motivation, and outcome expectancy towards already existing recommendations for palliative care and (2) to evaluate the self-experienced competence in five medical key topics presented in the new guideline.

Methods

A web-based online survey with all DGP members in 2014 using a specifically designed questionnaire including 62 questions was used. Independent predictors for identified barriers were analysed using multivariable logistic regression analyses.

Results

All 4786 members with known email address were invited, 1181 followed the link, 1138 began to answer, and 1031 completed the questionnaire. Fifty-four percent know already existing recommendations concerning palliative care, 8.4% know and use these recommendations; of the latter group, 44.2% do not notice any improvement of their treatment when applying them. Of key symptoms addressed in the guideline, depression was the symptom with lowest perceived competence (63.7 vs. > 90% for other symptoms). Non-physicians and those working in settings with little contact to seriously ill or dying patients feel less competent in almost all symptoms.

Conclusion

Emphasis on the high-quality and evidence- and consensus-based character of the guideline should be underlined in future implementation processes. Implementation strategies should focus on depression and non-physicians and those professionals working in settings with little contact to seriously ill patients.

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Acknowledgements

The authors would like to thank all participating members of the German Association for Palliative Care (DGP).

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Affiliations

  1. Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Helen Kalies, Rieke Schöttmer & Claudia Bausewein

  2. Center for Palliative Medicine, University of Cologne, Kerpener Str. 62, 50924, Köln, Germany

    Steffen T Simon & Raymond Voltz

  3. Institute of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Alexander Crispin

Authors
  1. Helen Kalies
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  2. Rieke Schöttmer
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  3. Steffen T Simon
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  4. Raymond Voltz
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  5. Alexander Crispin
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  6. Claudia Bausewein
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Corresponding author

Correspondence to Claudia Bausewein.

Ethics declarations

The study was approved by the research ethics committee of the University of Cologne (application number 14-097).

Conflict of interest

The authors declare that they have no conflict of interest.

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Kalies, H., Schöttmer, R., Simon, S.T. et al. Barriers for the implementation of guidelines in palliative care—results from a national survey of professionals. Support Care Cancer 26, 1943–1952 (2018). https://doi.org/10.1007/s00520-017-4030-z

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  • DOI: https://doi.org/10.1007/s00520-017-4030-z

Keywords

  • Palliative care
  • Guidelines
  • Implementation
  • Barriers and enablers
  • Predictors
  • National survey
  • Germany