Abstract
BackgroundClinical variation in ovarian cancer care has been reported internationally. Using Wennberg’s classification of clinical variation as effective care we can conceptualise variation through deviation from clinical guidelines. The aim of this review was to address knowledge gaps in the effectiveness of attempts to reduce unwarranted clinical variation through addressing the following questions: What is the evidence of guideline adherence in ovarian cancer and its deviation?; what are the key factors associated with variation in guideline adherence in ovarian cancer care?; and what quality improvement approaches have been used and what is the evidence of their effectiveness in enhancing guideline adherence in ovarian cancer care?.MethodsKeywords and synonyms for the major concepts of ovarian cancer, guideline adherence and safety were developed and combined to form the search strategy. Systematic searches of four electronic databases were undertaken of publications from January 2007 to November 2018. Retrieved articles were assessed against the eligibility criteria to determine those for inclusion.ResultsThirty-two papers were included in the review with three broad groupings identified: adherence to and deviation from guidelines (either local, national or international guidelines); factors impacting guidelines adherence; and quality improvement approaches.ConclusionsUnwarranted clinical variation may be used as a marker for the effectiveness of a health system, based on the outcome of this systematic review. This review found that the implementation of quality indicators through a formal quality improvement program lead to improvements in guideline adherent care. Further research on outcomes of implementing quality improvement programs in ovarian cancer care will improve the ability to implement centralised care and further identify factors that to improve outcomes in ovarian cancer care.
Highlights
Clinical variation in healthcare describes differences in healthcare practice, processes or outcomes for reasons such as the complexity of a patient’s illness, the burden of illness in different populations, or administrative differences, such as different coding of the same issue [1]
This review aims to address these knowledge gaps by providing a synthesis of evidence in relation to the following questions: (1) What is the evidence of guideline adherence in ovarian cancer and its deviation?; (2) What are the key factors associated with variation in guideline adherence in ovarian cancer care?; (3) What quality improvement approaches been used and what is the evidence of their effectiveness in enhancing guideline adherence in ovarian cancer care?
Excluded studies Of the 1651 studies excluded, 185 were excluded due to wrong study design, 28 were excluded due to focussing on cancer screening and 427 were excluded as they focused on quality improvement broadly and did not focus on guideline adherence and clinical variation
Summary
Clinical variation in healthcare describes differences in healthcare practice, processes or outcomes for reasons such as the complexity of a patient’s illness, the burden of illness in different populations, or administrative differences, such as different coding of the same issue [1]. Such variations are evident throughout healthcare systems and services internationally and reflect natural differences between the individuals and population groups receiving care. A population based study from Australia found variation in the provision of standard chemotherapy treatment for women older than 70 years with ovarian cancer, with 68% of these women not receiving standard chemotherapy [5].
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