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For Immediate Release: December 9, 2010
Association of Community Cancer Centers Releases Study on Use of Clinical Practice Guidelines in the Community Oncology Setting
Oncologists Face Barriers to Following Clinical Guidelines for Treatment
ROCKVILLE, Md.—The Association of Community Cancer Centers (ACCC) has released a study designed to help cancer care providers better understand common barriers associated with clinical practice guideline (CPG) adherence. Despite positive attitudes about CPGs overall, respondents cite many barriers to using guidelines consistently, effectively, and efficiently in the healthcare setting.
“In a field as rapidly changing as oncology, clinical practice guidelines are an important resource for providers using evidence-based medicine,” said ACCC President Al B. Benson III, MD, FACP. “Still, evidence suggests that adherence to practice guidelines in the community oncology setting is uneven. ACCC’s study takes a critical step toward finding solutions to inconsistencies in CPG usage, identifying barriers to usage, and understanding differences within institutions and across disciplines.”
In March 2010 ACCC proposed a unique needs assessment to address the use of CPGs in the community oncology setting. ACCC identified 50 hospital cancer programs and oncology group practices that use CPGs and developed a survey that a medical oncologist, oncology nurse, and oncology pharmacist at each program were asked to take. Survey results were tabulated and analyzed.
Findings show that within a cancer program or group practice, the attitudes about CPGs across the physician, nurse, and pharmacist are highly consistent, suggesting that culture may lead to agreement on the utility of guidelines and their positive impact on patient care. However, physicians and nurses disagree on the frequency with which physicians implement guidelines in clinical practice. Nurses are almost as likely to overestimate as they are to underestimate physician adherence to CPGs, when compared to their corresponding physicians’ responses.
All provider types estimate that physicians apply guidelines-based care more than 80 percent of the time. Physicians self-report that they adhere to guidelines in 84 percent of cases. Estimates of the percentage of time physicians follow guidelines vary: physicians estimate 50 to 100 percent; nurses, 25 to 100 percent; and pharmacists 20 to 100 percent.
The cautionary news is that oncology providers report real barriers to actually following the recommended guidelines, which often results in physicians creating their own. Reported barriers to CPG use include:
- Guidelines are too rigid or not appropriate for the unique clinical situation
- Guidelines are difficult to locate or implement
- Physicians do not have enough time to refer to guidelines
- Guidelines require a significant change of practice.
Survey results show that nearly all programs and practices have at one point created their own guidelines, with a quarter of respondents creating them often or always. Programs and practices are more likely to generate guidelines for breast, lung, and GI cancers.
A key to reducing barriers is making CPGs more easily accessible. The study noted that the most common way for physicians to access guidelines is online, either through medical journals or guideline statements. Many physicians report, however, that health information technology (HIT) tools, such as customized electronic medical records and clinical decision support modules, would make it easier to provide evidence-based care. Nonetheless, few respondents have these tools currently in place.
“Despite the barriers to CPG use, ACCC’s landmark study documents a perception of high guideline use among oncologists and likely non-physician practitioners as well,” said ACCC Guidelines Committee Chairman Alan S. Weinstein, MD, FACP. “Guidelines are essential in patient-centered care. Patients are comforted by the fact that there is solid evidence backing why the practitioner has chosen a particular type of treatment.”
From ACCC’s perspective, evidence-based CPGs facilitate consistency, which supports efficiency within the interdisciplinary team. CPGs also provide a base that supports the mandates for comparative effectiveness studies and establishes evidence of compliance with pay for performance (P4P) quality requirements.
This educational program was made possible through an educational grant from sanofi-aventis U.S. Avalere Health provided strategic advisory services and analysis for this project.