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Table 1 Study characteristics, taxonomy strategies used in interventions, and summary of study outcomes

From: Effectiveness of guideline dissemination and implementation strategies on health care professionals’ behaviour and patient outcomes in the cancer care context: a systematic review

Study (country)Study designParticipantsSettingCPGbMazza taxonomy strategiesOutcomesc
HCPPatientsExperimental conditionaComparator conditionPrimary (HCP level)Secondary (patient-level)
Aspy et al. [28] (USA)RCTPrimary care providersBreastOutpatientScreening1.5 Educate individual
1.12 Feedback about patients
3.1.1Additional human resources
No interventionN/A+ Screening rate
Ayanian et al. [29] (USA)RCTPrimary care physiciansColorectalOutpatient
Inpatient
Screening1.9 Provide remindersNo interventionN/A+ Test completion
+ Detection of cancer
Bertsche et al. [30] (Germany)QEPhysicians, nurses, pharmacistsTumour painInpatientAppropriate symptom management1.2 Distribute guideline
1.5 Educate individual
1.12 Feedback about patients
3.3.4 Change in technology
No interventionAntecedent (acceptance of recommendations; N.R.)
+ Behaviour (deviations from guideline)
+ Symptom management
Burack et al. [31] (USA)RCTPrimary care physicians, internal medicine, gynaecologyCervicalOutpatientScreening1.9 Provide reminders
Patient-directed strategy
1.9 Provide remindersNo interventionN/AØ Test completion
Carney et al. [32] (USA)RCTRadiologistsBreastOutpatientScreening -1.5 Educate individual
1.11 Feedback guideline compliance
1.12 Feedback about patients
1.15 Other—goal setting
No interventionØ Behaviour (recall rate)N/A
Cohn et al. [33] (USA)QEObstetrician-gynaecologists, physiciansCervicalOutpatientScreening1.2 Distribute guideline
1.3 Advertise guideline
1.5 Educate individual
1.5 Educate individual
1.9 Provide reminders
Patient-directed strategy
1.2 Distribute guideline
1.5 Educate individual
1.5 Educate individual
1.9 Provide reminders
No intervention+ Antecedent (knowledge of guideline)
+ Antecedent (exposure to guidelines)
+ Antecedent (patient history)
N/A
Coleman et al. [34] (USA)QENurses, physicians, mammography techniciansBreastOutpatientScreening1.5 Educate individual
1.9 Provide reminders
1.12 Feedback about patients
Patient-mediated strategy
No interventionØ Antecedent (knowledge and attitude)
Antecedent (skill; N.R.)
Ø Screening rate
Du Pen et al. [35] (USA)RCTOncology nurses, oncologistsCancer painOutpatientAppropriate symptom management1.2 Distribute guideline
1.6 Educate group
1.7 Recruit opinion leader
1.15 Other—algorithm
1.15 Other—algorithm+ Behaviour (total provider adherence)+ Symptom management (pain outcomes)
Du Pen et al. [36] (USA)RCTOncology nurses, oncologistsCancer pain (breast, lung, colorectal, prostate, pancreatic, ovarian, etc.)OutpatientAppropriate symptom management1.2 Distribute guideline
1.15 Other—algorithm
No interventionBehaviour (total provider adherence; N.R.)+ Symptom management
Ø Quality of life
Emery et al. [37]
(UK)
RCTGeneral practitioners, nursesBreast, colorectalOutpatientScreening1.5 Educate individual
1.6 Educate group
1.7 Recruit opinion leader
3.3.4 Change in technology
1.2 Distribute guideline
1.6 Educate groups
Antecedent (attitude; N.R.)
Antecedent (confidence; N.R.)
Antecedent (barriers; N.R.)
+ Behaviour (screening referral)
N/A
Ferreira et al. [38] (USA)RCTPhysicians, nursesColorectalOutpatientScreening1.6 Educate group
1.11 Feedback guideline compliance
1.12 Feedback about patients
1.14 Feedback from health care professionals
Patient-mediated strategy
No intervention+ Behaviour (screening recommendations)+ Screening rate
Ganz et al. [39] (USA)RCTPrimary care providers, nurses, administrative staffColorectalOutpatientScreening1.1 Identify barriers
1.2 Distribute guideline
1.6 Educate group
1.7 Recruit opinion leader
1.9 Provide reminders
1.14 Feedback from health care professionals
Patient-directed strategy
No interventionAntecedent (uptake of intervention; N.R.)Ø Screening rate
Gorin et al. [40] (USA)RCTPrimary care physiciansBreastOutpatientScreening1.5 Educate individual
1.6 Educate group
1.9 Provide reminders
Patient-directed strategy
No intervention+ Antecedent (knowledge)
+ Antecedent (perception of barriers)
+ Behaviour (screening recommendation)
+ Screening rate
Hillman et al. [41] (USA)RCTPrimary care providersBreast,
cervical, colorectal
OutpatientScreening1.12 Feedback about patients
2.1.2 Incentive to institution
No interventionØ Behaviour (screening recommendations)N/A
Hountz et al. [42] (USA)QENursesColorectalOutpatientScreening1.6 Educate group
1.11 Feedback guideline compliance
3.3.4 Change in technology
Patient-directed strategy
No intervention+ Behaviour (screenings ordered)+ Test completion
Kerfoot et al. [43] (USA)RCTPrimary care physicians, nurses, physician assistantsProstateOutpatientScreening -1.11 Feedback guideline complianceNo interventionAntecedent (knowledge; N.R)
+ Behaviour (antigen screening deviations)
N/A
Lane et al. [44] (USA)QEPrimary care physiciansBreastOutpatientScreening1.5 Educate individual
1.13 Feedback from patients
No interventionØ Behaviour (screening referral)N/A
Lane et al. [45] (USA)RCTPhysicians, nurses, physician assistantsColorectalOutpatientScreening1.1 Identify barriers
1.6 Educate group
1.8 Achieve consensus
3.1.2 Reallocated roles
3.1.3 Implementation team
No intervention+ Behaviour (screening referral)N/A
Ling et al. [46] (USA)RCTFamily practice, internal medicine physiciansColorectalOutpatientScreening1.1 Identify barriers
1.6 Educate group
1.10 Provide alerts
3.1.6 Other—development of protocols
3.1.6 Other—changing intervention to facilitate ease of use
Patient-directed strategy
1.10 Provide alerts
1.6 Educate groups
3.1.6 Other—development of protocols
Patient-directed strategy
N/A+ Test completion
Manfredi et al. [47] (USA)RCTPrimary care physiciansBreast, cervical, colorectalOutpatientScreening1.3 Advertise guideline
1.4 Present guideline
1.6 Educate group
1.10 Provide alerts
1.11 Feedback guideline compliance
3.3.5 Change in quality assurance
1.3 Advertise guidelineN/A+ Test completion
McDonald et al. [48] (USA)RCTNursesCancer painOutpatientAppropriate assessment/instruction practices1.2 Distribute guideline
1.3 Advertise guideline
1.9 Provide reminders
3.1.1 Additional human resources
1.3 Advertise guideline
1.9 Provide reminders
No interventionØ Behaviour (pain assessment)Ø Symptom management and quality of life
Myers et al. [26, 27] (USA)RCTPrimary care physiciansColorectalOutpatientScreening1.1 Identify barriers
1.6 Educate group
1.9 Provide reminders
1.11 Feedback guideline compliance
1.12 Feedback about patients
1.9 Provide reminders+ Behaviour (screening)+ Screening rate
Ornstein et al. [49] (USA)RCTPrimary care physicians, nursesColorectalOutpatientScreening1.4 Present guideline
1.11 Feedback guideline compliance
1.12 Feedback about patients
1.15 Other—education on ‘best’ implementation strategies
3.1.2 Reallocated roles
1.4 Present guideline materials
3.12 Reallocated roles
+ Behaviour (method of screening)+ Test completion
Patil et al. [50] (India)QEPhysiciansN.R.OutpatientAppropriate symptom management1.3 Advertise guideline
1.11 Feedback guideline compliance
3.3.5 Change in quality assurance
4.1 Change in legislation
No intervention+ Behaviour (physician adherence; prescription overuse)N/A
Phillips et al. [51] (Australia)QENursesLung, breast, gynaecological, colorectal, otherInpatientAppropriate symptom management1.5 Educate individual
1.11 Feedback guideline compliance
No intervention+ Antecedent (knowledge)
+ Antecedent (confidence)
+ Behaviour (pain assessment and documentation)
N/A
Raj et al. [52] (Norway)QEOncologistsBreast, prostate, colorectal, lymphoma, lung, testicular, anal, upper gastrointestinal, otherOutpatientPain management1.12 Feedback about patients
3.3.4 Change in technology
No interventionØ Behaviour (prescription)Ø Symptom management (pain outcomes)
Rat et al. [53] (France)RCTGeneral practitionersColorectalOutpatientScreening1.12 Feedback about patients1.11 Feedback guideline complianceNo intervention+ Behaviour (screening)N/A
Ray-Coquard et al. [54] (France)QEPhysiciansBreast, colonOutpatientAppropriate treatment sequence (screening, procedures, continuity of care)1.2 Distribute guideline
1.6 Educate group
1.7 Recruit opinion leader
1.8 Achieve consensus
No interventionBehaviour (compliance with CPG; Ø breast; + colon)N/A
Ray-Coquard et al. [55] (France)QEPhysiciansBreast, colonOutpatientAppropriate treatment sequence (screening, procedures, continuity of care)1.2 Distribute guideline
1.6 Educate group
1.8 Achieve consensus
No intervention+ Behaviour (compliance with CPG)N/A
Roila et al. [56] (Italy)RCTOncologistBreast, lung, ovary, colorectal, otherInpatientAppropriate symptom management1.2 Distribute guideline
1.6 Educate group
1.11 Feedback guideline compliance
1.2 Distribute guideline
1.11 Feedback guideline compliance
1.2 Distribute guideline+ Behaviour (prescription)N/A
Sequist et al. [57] (USA)RCTPrimary care physiciansColorectalOutpatientScreening1.9 Provide reminders
Patient-mediated strategy
1.9 Provide remindersPatient-mediated strategyNo interventionAntecedent (attitude; N.R.)Ø Screening rate
+ Detection of cancer
Walsh et al. [58] (USA)RCTPrimary care physiciansColorectalOutpatientScreening1.1 Identify barriers
1.5 Educate individual
1.6 Educate group
1.7 Recruit opinion leader
Patient-mediated strategy
1.6 Educate groupsN/AØ Screening rate
Wright et al. [67] (Canada)RCTPhysiciansColonOutpatientAccuracy of diagnosis1.5 Educate individual
1.6 Educate group
1.7 Recruit opinion leader
1.9 Provide reminders
1.6 Educate groupsØ Behaviour (staging)N/A
  1. CPG clinical practice guideline, HCP health care professional, N/A not measured in study so not applicable, N.R. measured in study but not reported, QE quasi-experimental, RCT randomized controlled trial, UK United Kingdom, USA United States of America
  2. aWhere there are two sets of strategies it indicates the presence of multiple experimental groups within a study; where strategies are repeated it indicates the coding of the same strategy in two distinct components of the intervention
  3. bDirection of the recommendation is to increase behaviour, with the exception of one study as indicated with ‘–‘
  4. c‘+’represents positive and significant changes and a ‘Ø’ represents a null finding