Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T04:47:15.688Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinicians' assessments of practice guidelines in oncology: The CAPGO survey

Published online by Cambridge University Press:  01 November 2004

Melissa C. Brouwers ,
Ian D. Graham ,
Steven E. Hanna ,
David A. Cameron  and
George P. Browman
Melissa C. Brouwers
Affiliation:
Cancer Care Ontario McMaster University
Ian D. Graham
Affiliation:
University of Ottawa
Steven E. Hanna
Affiliation:
McMaster University
David A. Cameron
Affiliation:
McMaster University
George P. Browman
Affiliation:
Cancer Care Ontario McMaster University Hamilton Regional Cancer Centre
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Promoting the adoption of clinical practice guidelines is a challenging task. Research shows that adopters' beliefs about guidelines and the process of their development are important predictors of guideline use. Our objective is to report on the development and refinement of an instrument designed to measure oncologists' assessments of guidelines in oncology.

Method: A theoretically derived instrument was drafted. Oncologists were asked to complete a questionnaire for each draft guideline they were asked to review. Factor analyses and multilevel modeling techniques were undertaken to explore the properties of the instrument and refine it.

Results: A total of 488 Ontario clinicians were sent 1,494 new questionnaires regarding 34 clinical practice guidelines produced between 1999 and 2002. A refined eighteen-item questionnaire with four stable factors that predicted 60 percent of the variance emerged. The factors are interpreted as guideline quality, applicability, acceptability, and comparative value. The four factors predicted oncologists' endorsements of draft guidelines and, with the exception of quality, predicted their intentions to use the guidelines. As expected, variation in the factor scores could be attributed more to the differences among the oncologist who completed the survey than to the differences among the guidelines themselves.

Conclusions:An instrument composed of four stable and theoretically relevant factors emerged. The findings support the hypothesis that beliefs about guideline attributes and development attributes relate to oncologists' endorsement of and intentions to use guidelines. Our next step is to link the responses of the survey with actual clinical behavior.

Keywords

Clinical practice guidelines
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 421 - 426
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cluzeau F, Burgers J, Brouwers M, et al. 2003 Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project. Qual Saf Health Care. 12: 18– 21.Google Scholar
Ajzen I, Fishein M. 1980. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall;
Browman GP, Levine MN, Mohide EA, et al. 1995 The practice guideline development cycle: A conceptual tool for practice guidelines development and implementation. J Clin Oncol. 13: 502– 512.Google Scholar
Browman GP, Newman TE, Mohide EA, et al. 1998 Progress of clinical oncology guidelines development using the practice guidelines development cycle: The role of practitioner feedback. J Clin Oncol. 16: 1226– 1231.Google Scholar
Cabana M, Rand CS, Powe NR, et al. 1999 Why don't physicians follow clinical practice guidelines? JAMA. 282: 1458– 1465.Google Scholar
Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine. In: Field MJ, Lohr KN, eds. 1990. Clinical practice guidelines: Directions for a new program. Washington, DC: National Academy Press;
Conroy M, Shannon W. 1995 Clinical guidelines: Their implementation in general practice. Br J Gen Pract. 45: 371– 375.Google Scholar
Davis DA, Taylor-Vaisey A. 1997 Translating guidelines into practice. A systematic review of theoretic concepts, practice experience, and research evidence in the adoption of clinical practice guidelines. CMAJ. 157: 408– 416.Google Scholar
Eagly AH, Chaiken S. 1993. The psychology of attitudes. Fort Worth, TX: San Diego: Harcourt Brace Javanovich College Publishers;
Feather NT, ed. 1982. Expectations and actions: Expectancy-value models in psychology. Hillsdale, NJ: Erlbaum;
Fishbein M, Ajzen I. 1975. Belief, attitude, intentions and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley;
Goldstein H. 1987. Multilevel models in educational and social research. London: Oxford University Press;
Grimshaw JM, Russell IT. 1993 Achieving health gain through clinical guidelines. I. Developing scientifically valid guidelines. Qual Health Care. 2: 243– 248.Google Scholar
Grol R. 2001 Success and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 39 (Suppl 2): 1146– 1154.Google Scholar
Grol R. 1993 Development of guidelines for general practice care. Br J Gen Pract. 43: 146– 151.Google Scholar
Grol R. 2000 Implementation of evidence and guidelines in clinical practice: A new field of research. Int J Qual Health Care. 12: 455– 456.Google Scholar
Grol R, Dalhuijsen J, Thomas S, et al. 1999 Attributes of clinical practice guidelines that influence use of guidelines in general practice: Observation study. BMJ. 317: 858– 861.Google Scholar
Klein R. 1998. Principles and practice of structural equation modelling. New York: Guilford Press;
Mittman BS, Tonesk X, Jacobson PD. 1992 Implementing clinical practice guidelines: Social influence strategies and practitioner behavior change. Qual Rev Bull. 8: 413– 422.Google Scholar
Rogers EM. 1983. Diffusion of innovations. 3rd ed. New York: Free Press;
Rosser WW, Davis D, Gilbart E, Guideline Advisory Committee. 2001 Promoting effective guideline use in Ontario. CMAJ. 165: 181– 182.Google Scholar
Rosser WW, Davis D, Gilbart E. 2001 Assessing guidelines for use in family practice. J Fam Pract. 50: 969– 973.Google Scholar
Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. 1999 Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 281: 1900– 1905.Google Scholar
Streiner DL, Norman GR. 1989. Health measurement scales. A practical guideline to their development and use. Oxford: Oxford Medical Publishing;
Thomson R, Lavender M, Madhok R. 1995 How to ensure that guidelines are effective. BMJ. 311: 237– 242.Google Scholar
Tornatzky LG, Klein KJ. 1982 Innovation characteristics and innovation adoption-implementation: A meta-analysis of findings. J Evol Econo Trans Engineer Manag. EM-39: 28– 45.Google Scholar