Clinician-led Improvement in Cancer Care
27 October 2014 Last updated:
29 October 2014
Improving the evidence-based care for locally advanced prostate cancer and the use of clinical networks to lead changes in clinical practice for high-risk patients in hospitals.
This study will provide crucial evidence about how to develop effective implementation strategies that can be delivered through clinical networks to embed recommended care into practice to improve patient outcomes.
The study will be one of the first randomised trials to test the effectiveness of delivering implementation strategies through clinical networks to lead changes in clinical practice in hospitals and improve evidence based care in Australia.
The National Health and Medical Research Council (NHMRC) partnership grant is co-funded by the Prostate Cancer Foundation of Australia (PCFA). It commenced in November 2011 and is due to conclude in June 2016.
Assess whether a clinician-led, multi-faceted implementation strategy in nine NSW hospitals within the Urology Network (with urology multidisciplinary teams) increases evidence-based care for patients with high-risk prostate cancer following surgery and identify reasons why change in behaviour and outcomes did or did not occur.
The implementation strategies developed in this study can be adapted and tested through other clinical networks focused on a range of clinical areas (e.g. renal services, cardiac conditions) where there is an identified evidence-practice gap, to effect system change and improve patient outcomes.
The findings from this research will have an immediate effect in improving cancer care across NSW. The PCFA will develop dissemination tools to explain the implications of this study for consumers which will be published on its website.
Implementation: The initiative is currently being implemented and tested.
Project started: 1 November 2011.
Estimated completion date: June 2016.
In 2008, the ACI (then the Greater Metropolitan Clinical Taskforce, GMCT) entered into a research partnership with the Sax Institute to examine the impact of clinical networks drawing on the expertise within the GMCT and national and international research experts from a range of institutions. This work was complemented by an NHMRC partnership grant that investigated the determinants of effective clinical networks.
In 2010, the ACI identified a need to test implementation strategies to bring about practice change. A NHMRC partnership study was designed in consultation with the ACI Urology Network to test an implementation strategy. Members of the Network and Agency Executive are an integral part of the investigator team.
Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery so there is substantial room for improvement.
The CLICC trial, supported by the ACI Urology Network, commenced in 2011. It has been implemented in nine NSW hospitals that are part of the Urology Network from 2013, to test an implementation strategy to improve uptake of guideline recommended care for men with high-risk prostate cancer.
CLICC was developed through a multi-component needs and barriers analysis including:
- iterative workshops with members of the Urology Network
- a national survey of urologist members of the Urological Society of Australia and New Zealand (USANZ)
- semi-structured interviews with urology, radiation oncology, and nursing staff at target hospitals to explore site specific practice and barriers
- consumer feedback on what information patients want from their urologist
- consultation with a cancer policy advisory group to ensure intervention elements are feasible, scalable and potentially translatable to other cancers.
CLICC components include:
- Introductory video
- Printed materials
- Quarterly audit and feedback reports
- Automated flagging system for multidisciplinary team discussion
- Peer opinion leaders
See study protocol for full details: Brown et al. Implementation Science. 2014, 9:64. Clinician-Led Improvement in Cancer Care (CLICC) - Testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: Phased randomised controlled trial - Study protocol.
In phase 1 (phased randomised cluster trial), outcome data (referral to radiation oncology) will be assessed through review of patient medical records.
In phase 2 (mixed methods study) clinician knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change.
CLICC is a collaboration between the Sax Institute, NSW Agency for Clinical Innovation (ACI), Prostate Cancer Foundation of Australia, Cancer Council NSW and the University of Sydney.
A/Prof Mary Haines
Director, Implementation Research Group
Phone: 02 9188 9570
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