Introduction
Clinical Practice Guidelines (CPGs) summarise the best evidence to guide clinical decisions. There are limited studies examining adherence to cancer-specific CPGs. This systematic review analysed the literature regarding perceived barriers and facilitators to adherence to CPGs for active cancer treatment.
Methods
Registration: CRD42019125748. Six databases were systematically searched (Embase, Scopus, Ovid Medline, PsychInfo, CINAHL, PROQUEST), and identified abstracts were screened for eligibility. Full texts of potentially eligible papers were reviewed. All included studies were assessed for quality, and data were extracted. Qualitative data were analysed thematically, and quantitative data were categorized by attitudes, barriers and facilitators to CPG adherence.
Results
The database search identified 9,676 titles. After abstract screening and full text review, 15 studies were included in the study. Eight themes were identified: Barriers (Poor CPG content and currency, Limited evidence, Clinician uncertainty, and Organisational and patient-centered factors), and Facilitators (CPG accessibility, Endorsement, dissemination and access to treatment facilities, and Awareness of CPGs, and Belief that CPGs support decision making, improve patient care, and reduce costs). Key factors specifically related to cancer treatment CPG adherence included: as barriers, infrequent CPG updates, the presence of contradictory CPGs, clinical experience of patient side effects, and patient age and frailty; and as facilitators, locally adapted CPGs, organisational support, CPG development by trusted bodies, and CPGs supporting treatment decisions when access to multidisciplinary peer review is limited. The review also identified factors in common with the general CPG adherence literature.1
Conclusion
These findings will inform the development of tailored cancer treatment CPG implementation strategies, with the intention of increasing the rate of CPG adherence.