Implementing clinical practice guidelines

To ensure that prostate cancer patients have the best treatments and outcomes, their care ought to be based on the best available evidence. Unfortunately, it is known that this does not always happen and it is recognised that the explanations for why it does not happen are varied and complex. However, it is possible to investigate, understand and change healthcare professional behaviours and organisational practices to reflect the best evidence through an integrated research process.

Communicating the best evidence to healthcare professionals about which treatments work, for which patients, under what circumstances, is often done via clinical practice guidelines, which are “statements that include recommendations intended to optimise patient care that are informed by a systematic review of evidence and assessment of the benefits and harms of alternative care options” (Sternberg et al 2011). Guideline compliant practice improves quality and outcomes of health care (Davis et al 1997). Ultimately, healthcare systems, governments and private insurers depend on guidelines to optimize the effectiveness and cost-effectiveness of health care. Many scientific societies develop these guidelines for the management of urological diseases. However, simply publishing these guidelines is not enough and active steps must be taken toward dissemination and implementation – a process which is understood theoretically, but in practice is difficult to implement in complex organisations such as the NHS.

Prostate cancer is among the commonest cancers diagnosed in men, a leading cause of male deaths, and the incidence is increasing. Although survival is favourable with localised disease, men with more advanced disease have worse outcomes. It is imperative that we use the best scientific evidence available to diagnose and treat these men. For example, when considering adherence to prostate cancer guidelines and the use of androgen deprivation therapy (or hormone treatment), it has been reported that approximately one out of four patients received hormone treatment when this was not recommended by guidelines (Morgia et al 2016). Of these, roughly 50% received hormone treatment before surgery which is currently strongly discouraged by guidelines recommendations (Mottet et al 2017). Such misuse of hormone treatment is associated with both increased unnecessary costs for the healthcare system and much higher rates of avoidable side effects for prostate cancer patients.

What can be done to improve treatment of prostate cancer through better adherence to guidelines?
Active ‘Implementation’, involves “…identifying and assisting in overcoming the barriers to the use of the knowledge obtained from a tailored message … which uses not only the message itself, but also organisational and behavioural tools that are sensitive to constraints and opportunities of identified physicians in identified settings” (Lomas, 1993). Effective implementation of prostate cancer treatment guidelines involves the identification of barriers to implementation and the identification of the optimum interventions to limit or overcome such barriers. This is so that the most appropriate treatments are targeted at and delivered to prostate cancer patients who will benefit the most, allowing for the optimisation of healthcare resources whilst eventually improving prostate cancer patient outcomes.
The gap between evidence-based prostate cancer treatment recommendations and the prostate cancer care actually given to patients may be due to a multitude of barriers. These barriers exist at different levels within the healthcare systems including structural (e.g., financial disincentives), organisational (e.g., inappropriate skill, lack of facilities or equipment), peer group, professional and cognitive barriers. Once the barriers and facilitators are understood, then implementation interventions may be designed to help enhance facilitators and overcome barriers.

What will we do to address this problem?
During this PhD project the successful student will be involved in a series of studies to address these gaps in understanding and to develop and pilot suitable interventions. This will include estimating adherence to strong prostate cancer diagnosis and treatment guideline recommendations which are underpinned by high quality evidence (study 1), understanding why some prostate cancer diagnosis and treatment guideline recommendations are not followed (study 2), and designing interventions to improve adherence to recommendations (study 3).

APPLICATION PROCEDURE:
This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php. You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.

NOTE CLEARLY THE NAME OF THE SUPERVISOR AND EXACT PROJECT TITLE ON THE APPLICATION FORM. Applicants are limited to applying for a maximum of 3 applications for funded projects. Any further applications received will be automatically withdrawn.