Clinical practice guidelines (CPGs) in oncology provide a collation of evidence-based, consensus-driven clinical treatment and management best practices to assist physicians in making difficult treatment decisions for patients. However, there is nonuniform adherence to CPGs across cancer types, which affect patient care favorably or unfavorably, depending on the circumstances. Timeliness of appropriate care and individualized care are also a challenge in care delivery. There has been a shift in the approach to quality care as stakeholders are refocusing on patient values and priorities, resulting in patient-reported outcome (PRO) tools to better collect patient feedback. This information is most valuable when applied through real-time interventions. The articles in this issue explore the barriers to CPG adherence and how PRO data has been captured and integrated into care processes in real time.
Prior research has postulated that a lack of adherence to CPGs by oncologists may be related to a lack of sufficient quality in guideline development, financial conflicts among the authors designing the CPGs, and additional internal and external barriers for physicians. In their article, Mihaela C Munteanu, EdD, MS, and John M Burke, MD, explore the barriers to lymphoma CPGs through physician surveys and follow-up interviews. Multiple themes emerged and differences in perceived barriers were reported by physicians in academic vs nonacademic settings. This preliminary study provides unique insights into the field of lymphoma CPGs, how physicians from multiple settings and groups perceive and use them, and what barriers exist to consistent CPG adherence by lymphoma doctors in the United States.
Until recently, most quality measures have focused on care processes, the absence or presence of adverse events, and mortality, with less emphasis placed on the quantitative measurements of functional outcomes, symptoms, and quality of life. PRO tools allow for a patient’s expression of his/her own concerns and needs within the context of one’s personal life experiences. These tools have been used in clinical research for some time; however, their application in real-time clinical intervention and performance measurement remains in its infancy. Diane Denny, DBA, MHA, FACHE, CPHQ, CPPS, and colleagues describe the implementation of a PRO tool in multiple oncology centers as its use evolved from episodic to continuous measurement, and from a research-based focus to one promoting real-time clinical intervention. Benefits of this approach are discussed from the perspective of the patient and clinician along with a description of each deliverable achieved throughout implementation and subsequent refinement.
