Background: Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions. It is one of three sub-studies within the Children’s Oncology Group (COG) study ACCL15N1CD.
Methods: Healthcare professionals at 26 pediatric, COG-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. CPG implementation facilitators and barriers were solicited using nominal group technique (NGT) and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from analysis of NGT items were identified, first from each focus group and then across all focus groups.
Results: Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were: organizational factors, individual factors, user needs and values, system factors and implementation strategies. The top five barriers of CPG implementation identified were: organizational factors, individual factors, system factors, user needs and values, and professional.
Conclusions: Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs and eliminate implementation barriers.
Trial registration: ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016.