Promoting the Implementation of Best-Practice Guidelines Using a Matrix Tool

Abstract

Background/Objectives

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.

Methods

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.

Results

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.

Conclusions

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.