- Title
- A multidisciplinary team-oriented intervention to increase guideline recommended care for high-risk prostate cancer: A stepped-wedge cluster randomised implementation trial
- Creator
- Brown, Bernadette; Young, Jane; Smith, David P.; Kneebone, Andrew B.; Brooks, Andrew J.; Egger, Sam; Xhilaga, Miranda; Dominello, Amanda; O'Connell, Dianne L.; Haines, Mary
- Relation
- Implementation Science Vol. 13, no. 43, p. 1-12
- Publisher Link
- http://dx.doi.org/10.1186/s13012-018-0733-x
- Publisher
- BioMed Central
- Resource Type
- journal article
- Date
- 2018
- Description
- Background: This study assessed whether a theoretically conceptualised tailored intervention centred on multidisciplinary teams (MDTs) increased clinician referral behaviours in line with clinical practice guideline recommendations. Methods: Nine hospital Sites in New South Wales (NSW), Australia with a urological MDT and involvement in a state-wide urological clinical network participated in this pragmatic stepped wedge, cluster randomised implementation trial. Intervention strategies included flagging of high-risk patients by pathologists, clinical leadership, education, and audit and feedback of individuals' and study Sites' practices. The primary outcome was the proportion of patients referred to radiation oncology within 4 months after prostatectomy. Secondary outcomes were proportion of patients discussed at a MDT meeting within 4 months after surgery; proportion of patients who consulted a radiation oncologist within 6 months; and the proportion who commenced radiotherapy within 6 months. Urologists' attitudes towards adjuvant radiotherapy were surveyed pre- and post-intervention. A process evaluation measured intervention fidelity, response to intervention components and contextual factors that impacted on implementation and sustainability. Results: Records for 1071 high-risk post-RP patients operated on by 37 urologists were reviewed: 505 control-phase; and 407 intervention-phase. The proportion of patients discussed at a MDT meeting increased from 17% in the control-phase to 59% in the intervention-phase (adjusted RR=4.32; 95% CI [2.40 to 7.75]; p < 0.001). After adjustment, there was no significant difference in referral to radiation oncology (intervention 32% vs control 30%; adjusted RR=1.06; 95% CI [0.74 to 1.51]; p=0.879). Sites with the largest relative increases in the percentage of patients discussed also tended to have greater increases in referral (p=0.001). In the intervention phase, urologists failed to provide referrals to more than half of patients whom the MDT had recommended for referral (78 of 140; 56%). Conclusions: The intervention resulted in significantly more patients being discussed by a MDT. However, the recommendations from MDTs were not uniformly recorded or followed. Although practice varied markedly between MDTs, the intervention did not result in a significant overall change in referral rates, probably reflecting a lack of change in urologists' attitudes. Our results suggest that interventions focused on structures and processes that enable health system-level change, rather than those focused on individual-level change, are likely to have the greatest effect.
- Subject
- high-risk prostate cancer; discussion patients; Australia New Zealand clinical trials registry (ANZCTR); clincal leadership; adjuvant radiotherapy; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1451121
- Identifier
- uon:44096
- Identifier
- ISSN:1748-5908
- Rights
- This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Language
- eng
- Full Text
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