Implementation of geriatric assessment in oncology settings: A systematic realist review

Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research

Clinical Practice Patient Education Guideline to Combat Childhood Obesity

Childhood obesity is a global health problem, according to the World Health Organization (WHO), making it an epidemic. According to America’s Health Rankings, it has been estimated that 16.5% of children between the ages of 2 and 5 are overweight, and 15.7% of these children are obese. The gap in practice identified for this Doctor of Nursing Practice project was the lack of a standardized tool for patient education for children with weight issues. Due to the rise of childhood obesity, an evidence-based patient education guideline was developed for providers serving a community in the eastern United States where an estimated 20.6% of the youth between 12 and 19 years are obese. Seeking answers to the question of what current sources of evidence were available to develop a clinical practice pediatric guideline to address childhood obesity, a comprehensive review of the literature was conducted. Following the literature review, a panel of eight experts reviewed the clinical practice guideline using the AGREE II scoring instrument. The scores were high across all domains, with 98–100% agreement that the guideline met quality standards. Experts provided positive feedback, highlighting the clear, concise recommendations that were easy to understand and follow. Panelists recommended the guideline for broader dissemination through journal publication and distribution to pediatric clinics to optimize childhood obesity management. A wider implementation of this high-quality guideline has the potential for positive social change by standardizing and improving care across communities