Understanding the Most Frequently Experienced Barriers to the Adherence of Lymphoma Clinical Practice Guidelines (CPGs) and Their Effect on the Lymphoma Physicians' Utilization of CPGs: An Explanatory Mixed-Methods Study

Abstract

Clinical practice guidelines (CPGs) have been developed for almost all tumor types including lymphoma by medical and professional organizations. The CPGs have been developed to control the variability in clinical practice. When followed completely, these evidence-based practices are meant to provide an equal quality of treatment to all oncology patients. However, structural, behavioral, and environmental barriers to the adherence of lymphoma CPGs exist. The purpose of this sequential explanatory mixed methods study is to measure the most frequently experienced barriers to the adherence of lymphoma CPGs and explore how these barriers affect lymphoma physicians in the utilization of CPGs. The results revealed that among predictors such as the total score from each of three domains of barriers studied, sex, age group, region of practice, location of medical practice, and duration of medical practice examined, the social/environmental domain of barriers was statistically associated with the use of lymphoma CPGs (p=0.0089). The higher the score, the more likely is to implement lymphoma CPGs, whereas in the professional attitudes domain, the higher the score the less likely is to implement lymphoma CPGs such as the NCCN CPGs (p=0.0071). No association was found in the organizational domain of barriers. Additionally, statistically influential covariates in following lymphoma CPGs were observed in each of three domains of barriers. They are location of medical practice, advanced age, and geographical regions such as the South. While lymphoma doctors liked and found lymphoma CPGs to be evidence based they want to have more data known and published on how the adherence of lymphoma CPGs translates to positive patient outcomes and a decrease in healthcare costs. Subsequently, lymphoma doctors' expectations are to be able to make warranted exceptions when patients' comorbidities and variability exist without being called noncompliant. Technology should be reactive, proactive, and be utilized more efficiently in the implementation of CPGs and clinical pathways. Likewise, lymphoma doctors believe insurance plans need to change to provide uniformly a much better coverage for lymphoma patients' variability, drug tolerability, and lower-deductible costs in United States.Ed.D., Education -- Drexel University, 201