Dissemination and implementation: Translating cancer guidelines and clinical trial outcomes into everyday practice

As surgeons and surgical oncologists interested in advancing our field and in improving patient outcomes, it is important to us that practice-changing scientific research, clinical trials, and cancer guidelines be incorporated into clinical use in a timely fashion. However, estimates show that only 14 percent of original scientific research designed to improve patient care actually reaches the designated population of interest and takes more than 17 years to achieve even this impact.1

Cancer clinical trial outcomes are a significant component of this research base. Although they require a marked investment of financial and human resources, these outcomes data are unable to help the larger population of cancer patients in a timely and effective manner.

Dissemination and implementation research

Dissemination and implementation research has its roots in effectiveness and efficiency research, which dates back to the 1970s. In the 1990s, dissemination and implementation research programs started to expand and involve the intended stakeholders (patients, providers, payors, and policymakers) with, for example, the development of the Agency for Healthcare Research and Quality (AHRQ). This research approach, however, is still in its infancy.

Dissemination is defined as the “targeted distribution of information and intervention materials to a specific public health or clinical practice audience,” while implementation is “the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.”2 In short, the goal of dissemination and implementation processes is to package the created evidence, transmit it to the population of interest, and ensure it is received and adopted in its intended or appropriately modified form.

Dissemination strategies and implementation research programs include an array of qualitative research methods and designs that may not be immediately familiar to the practicing surgeon. However, several of the processes set forth by dissemination and implementation researchers include interventions that surgeons already use frequently, such as the multidisciplinary tumor board and community outreach programs.3 Each of these interventions is a component of the American College of Surgeons (ACS) Commission on Cancer (CoC) standards for accreditation.4

Community surgeons who treat cancer are most likely to learn of clinical trial outcomes from reading journals and at national meetings, but it is at local tumor conferences that surgeons can discuss with their peers how to incorporate the information into clinical practice. Presenting a case in a multidisciplinary venue and discussing how the trial results should affect management of a particular patient is one existing mechanism for dissemination.

New committee

The ACS Clinical Research Program (ACS-CRP), a component of the Alliance for Clinical Trials in Oncology, has recently developed a Dissemination and Implementation Committee charged with developing strategies for disseminating key cancer clinical trial results as well as designing implementation research programs for novel cancer guidelines. Key collaborators with this new committee are members of the CoC and the ACS-CRP committees on Education, Cancer Care Delivery Research, and Cancer Care Standards Development. Crucial to the growth of this program will be methodologists with expertise in dissemination and implementation research, as well as patient and cancer community advocates with an interest in moving guidelines and trial results to the larger cancer patient population.

One project that the ACS-CRP Dissemination and Implementation Committee will explore is the dissemination of critical elements of the operation set forth in the recently published Operative Standards for Cancer Surgery.5 How does the surgical cancer community ensure that each breast, pancreatic, colon, and lung operation follows the recommended operative steps detailed in this innovative manual? Will inclusion of each of these key practices improve cancer patient outcomes? These are the questions that the new committee intends to address.

Additionally and importantly, this group will be responsible for the dissemination of recent clinical trial results. In close association with the CoC, the ACS-CRP Dissemination and Implementation Committee seeks to ensure that each of the CoC-accredited hospitals can quickly incorporate clinical trial results and implement novel processes for making certain the community that would benefit from these trial results does so in a timely manner.

This new committee welcomes input from ACS Fellows, particularly your responses to the following types of questions: What are the things that most effectively give you the confidence and tools necessary to change your clinical practice in response to results of contemporary trials? How do you “operationalize” the new paradigms you read about or hear about at national meetings? The answers to these questions and the dissemination and implementation research associated with them will help the cancer community to shorten the 17-year gap from discovery to improved patient outcomes.

For more information on this committee, contact Lee G. Wilke, MD, FACS, at wilke@surgery.wisc.edu.


References

  1. Balas E, Boren S. Managing Clinical Knowledge for Health Care Improvement. In: van Bemmel JH, McCray AT, eds. Yearbook of Medical Informatics. Stuttgart, Germany: Schattauer Verlagsgesellschaft; 2000:65-70.
  2. National Institutes of Health Office of Extramural Research: Grants and funding. PAR-13-055: Dissemination and Implementation Research in Health (R01). Available at: http://grants.nih.gov/grants/guide/pa-files/PAR-13-055.html. Accessed December 18, 2015.
  3. Rycroft-Malone J, Seers K, Crichton N, et al. A pragmatic cluster randomised trial evaluating three implementation interventions. Implement Sci. 2012;7:80.
  4. ACS Commission on Cancer. Available at: facs.org/quality-programs/cancer/coc/about. Accessed November 15, 2015.
  5. Nelson HD, Hunt KK (eds). Operative Standards for Cancer Surgery, Volume 1. Chicago, IL: Wolters-Kluwer; 2015.

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