Promoting the Implementation of Best-Practice Guidelines Using a Matrix Tool
- 16 Downloads
Internationally, numerous clinical practice guidelines have been developed and disseminated with the intention of improving patient care. Research indicates that to improve practice in accord with clinical evidence, change is required by individual clinicians and teams of clinicians as well as at an organizational and policy level. A matrix framework has been developed by the Australian Cancer Network’s Guideline Implementation Steering Committee, using the theory of innovation adoption. The matrix is based on the characteristics of innovations that favor rapid adoption and wide acceptance. Within this construct, new clinical guidelines are equated to an ‘innovation’. The objective of the present study was to pilot this matrix tool to assess its usefulness for individuals and organizations aiming to develop strategies to promote guideline implementation in cancer care.
The matrix was piloted at a workshop with 50 attendees, primarily colorectal surgeons and oncologists. Six key areas relating to guidelines were included in the matrix: (i) compatibility with current practice; (ii) relative advantage over current practice; (iii) observability of outcomes; (iv) trialability; (v) simplicity of use; and (vi) perceived barriers. Three examples of guideline recommendations for the management of colorectal cancer were used during the pilot, covering evidence about best clinical care and psychosocial support: (i) people with high-risk rectal cancer should be referred for consideration of adjuvant preoperative or postoperative radiotherapy in a multidisciplinary setting; (ii) people with resected Dukes’ C (i.e. node-positive) colon cancer should be referred for consideration of adjuvant therapy in a multidisciplinary setting; and (iii) psychosocial interventions should be a component of care as they can improve the quality of life in patients with cancer. After discussion of the guideline examples, the attendees completed matrix tool forms to document their perceptions regarding the consistency of current practice with the example guidelines and barriers to practice change. Quantitative responses were assessed by frequency analysis and qualitative responses were assessed by thematic analysis.
There was consistency in the perceived views of workshop attendees around the six key areas included in the matrix. The perceived barriers that were highlighted by the respondents included the lack of available resources (staff, equipment, and funding); lack of multidisciplinary clinics, referral processes, and access to appropriate services; and lack of knowledge of benefit. Perceived facilitators of change included lead clinicians, consumer advocates, government, service administration, professional colleges, and cancer organizations.
The pilot process indicated that the matrix is a tool that could be of use to groups and individuals aiming to develop targeted change strategies to promote evidence-based practice improvement.
KeywordsImplementation Strategy Psychosocial Intervention Guideline Recommendation Health Service Delivery Guideline Implementation
We would like to thank the Colorectal Group of the Victorian Cooperative Oncology Group for piloting the matrix tool, and Susan Fitzpatrick (The Cancer Council Victoria) and Fiona Booth (National Breast Cancer Centre) for assistance with collation of the resultant data.
The authors did not receive any funding to assist with preparation of this study and have no conflict of interest related to the contents of the study.
- 1.CancerStats Monograph 2004. London, UK: Cancer Research UK, 2004Google Scholar
- 2.National Breast Cancer Centre. Clinical practice guidelines for the management of early breast cancer. 2nd ed. Canberra, Australia: National Breast Cancer Centre, 2001Google Scholar
- 3.Australian Cancer Network and National Breast Cancer Centre. Clinical practice guidelines for the management of women with epithelial ovarian cancer. Sydney, Australia: National Breast Cancer Centre, 2004Google Scholar
- 4.Clinical Oncological Society of Australia and Australian Cancer Network. Guidelines for the prevention, early detection and management of colorectal cancer. Canberra, Australia: National Health and Medical Research Council, 1999Google Scholar
- 5.Australian Cancer Network. Clinical practice guidelines for the prevention, diagnosis and management of lung cancer. Sydney, Australia: The Cancer Council Australia, 2004Google Scholar
- 6.Hill D, Jamrozik K, White V, et al. Surgical management of breast cancer in Australia in 1995. Sydney, Australia: National Breast Cancer Centre, 1999Google Scholar
- 7.Clinical Governance Unit 2002. The national colorectal cancer care survey: Australian clinical practice in 2000. Melbourne, Australia: National Cancer Control Initiative, 2002Google Scholar
- 15.Grimshaw JM, Thomas RE, MacLennan, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004; 8(6): 1–85Google Scholar
- 19.Ferlie E, Fitzgerald L, Wood M. Getting evidence into clinical practice: an organisational behaviour perspective. J Health Serv Res Policy 2000; 2: 96–102Google Scholar
- 23.Rogers EM. Diffusion of innovations. 4th ed. New York (NY): The Free Press, 1995Google Scholar