gms | German Medical Science

Background/research question: The production of guidelines alone does not necessarily translate into changes in clinical practice behaviour or better patient outcomes. This systematic review aims to identify recent clinical guideline implementation strategies and to determine their effect primarily on patient-relevant outcomes and secondarily on healthcare professionals' adherence in the oncological setting.

Methods: A systematic search of five electronic databases, PubMed, Web of Science, GIN on 16 August, CENTRAL on 17 August, and CINAHL on 21 September, was undertaken. Randomised controlled trials and non-randomised studies of interventions assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence 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.

Results: Of 1,058 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 2,024 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 increase referral rates slightly. 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.

Conclusion: The results should be interpreted with caution due to the low certainty of the evidence for referrals and very low certainty of the evidence for all other outcomes mostly caused by limitations in the study designs, indirectness of outcomes, and imprecision of the results. High-quality randomised controlled trials designed to primarily assess patient-relevant outcomes emerging from changes in the behaviour of healthcare professionals are needed. This systematic review gives an overview of the current state of research in this area and the findings can inform policymakers and professional organisations in the future development and adoption of implementation interventions in oncology.

Competing interests: No conflicts of interest declared.