Abstract
PurposeClinical practice guidelines (CPGs) can improve clinical care but uptake and application are inconsistent. Objectives were: to examine temporal trends in clinicians' evaluations of, endorsements of, and intentions to use cancer CPGs developed by an established CPG program; and to evaluate how predictor variables (clinician characteristics, beliefs, and attitudes) are associated with these trends.Design and methodsBetween 1999 and 2005, 756 clinicians evaluated 84 Cancer Care Ontario CPGs, yielding 4,091 surveys that targeted four CPG quality domains (rigour, applicability, acceptability, and comparative value), clinicians' endorsement levels, and clinicians' intentions to use CPGs in practice.ResultsTime: In contrast to the applicability and intention to use in practice scores, there were small but statistically significant annual net gains in ratings for rigour, acceptability, comparative value, and CPG endorsement measures (p < 0.05 for all rating categories). Predictors: In 17 comparisons, ratings were significantly higher among clinicians having the most favourable beliefs and most positive attitudes and lowest for those having the least favourable beliefs and most negative attitudes (p < 0.05). Interactions Time × Predictors: Over time, differences in outcomes among clinicians decreased due to positive net gains in scores by clinicians whose beliefs and attitudes were least favorable.ConclusionIndividual differences among clinicians largely explain variances in outcomes measured. Continued engagement of clinicians least receptive to CPGs may be worthwhile because they are the ones showing most significant gains in CPG quality ratings, endorsement ratings, and intentions to use in practice ratings.
Highlights
Evidence-based clinical practice guidelines (CPGs) are knowledge products defined as systematically developed statements aimed to assist clinicians and patients in making decisions about appropriate healthcare for specific clinical circumstances [1]
The Program in Evidence-based Care (PEBC) methods include the systematic review of clinical oncology research evidence by teams, i.e., disease site groups (DSGs) comprised of clinicians and methodological experts; interpretation and consensus of the evidence by the team; development of recommendations; and formal standardized external review of all draft CPGs [19,20,22]
Sample Between 1999 and 2005, 756 physicians participated in the evaluation of 84 specific cancer care CPGs developed in Ontario, yielding 4,091 Clinicians' Assessments of Practice Guidelines in Oncology (CAPGO) survey responses; more than 70% of clinicians rated more than one CPG
Summary
Evidence-based clinical practice guidelines (CPGs) are knowledge products defined as systematically developed statements aimed to assist clinicians and patients in making decisions about appropriate healthcare for specific clinical circumstances [1]. Health service researchers have debated the extent to which CPGs have been effective in influencing practice or clinical outcomes [2,3,4]. Systematic reviews by Grimshaw and colleagues suggest that CPGs, or similar statements, do on average influence both the processes and outcomes of care, the effect sizes tend to be modest [5,6,7]. Consistent with a social influence perspective, evidence has shown greater compliance with CPGs perceived to be compatible with existing norms and not demanding changes in existing practices [14]
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