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Supportive Care in Cancer

, Volume 26, Issue 6, pp 1943–1952 | Cite as

Barriers for the implementation of guidelines in palliative care—results from a national survey of professionals

  • Helen Kalies
  • Rieke Schöttmer
  • Steffen T Simon
  • Raymond Voltz
  • Alexander Crispin
  • Claudia BauseweinEmail author
Original Article

Abstract

Background

In 2015, an evidence- and consensus-based palliative care guideline in adults with incurable cancer was published by the German Guideline Program. Barriers and enablers for the guideline implementation of members of the German Association for Palliative Medicine (DGP) were unknown. Therefore, the aims of this study were (1) to evaluate professionals’ knowledge, motivation, and outcome expectancy towards already existing recommendations for palliative care and (2) to evaluate the self-experienced competence in five medical key topics presented in the new guideline.

Methods

A web-based online survey with all DGP members in 2014 using a specifically designed questionnaire including 62 questions was used. Independent predictors for identified barriers were analysed using multivariable logistic regression analyses.

Results

All 4786 members with known email address were invited, 1181 followed the link, 1138 began to answer, and 1031 completed the questionnaire. Fifty-four percent know already existing recommendations concerning palliative care, 8.4% know and use these recommendations; of the latter group, 44.2% do not notice any improvement of their treatment when applying them. Of key symptoms addressed in the guideline, depression was the symptom with lowest perceived competence (63.7 vs. > 90% for other symptoms). Non-physicians and those working in settings with little contact to seriously ill or dying patients feel less competent in almost all symptoms.

Conclusion

Emphasis on the high-quality and evidence- and consensus-based character of the guideline should be underlined in future implementation processes. Implementation strategies should focus on depression and non-physicians and those professionals working in settings with little contact to seriously ill patients.

Keywords

Palliative care Guidelines Implementation Barriers and enablers Predictors National survey Germany 

Notes

Acknowledgements

The authors would like to thank all participating members of the German Association for Palliative Care (DGP).

Compliance with ethical standards

The study was approved by the research ethics committee of the University of Cologne (application number 14-097).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Brueckner T, Schumacher M, Schneider N (2009) Palliative care for older people—exploring the views of doctors and nurses from different fields in Germany. BMC Palliat Care 8(1):7.  https://doi.org/10.1186/1472-684X-8-7 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Grilli R, Lomas J (1994) Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care 32(3):202–213.  https://doi.org/10.1097/00005650-199403000-00002 CrossRefPubMedGoogle Scholar
  3. 3.
    Hodgev VA, Kostianev SS, Torosian AA, Yanev IB, Mandoulova PB (2004) Long-term changes in dyspnea, lung function, and exercise capacity in COPD patients. Folia Medica (Plovdiv) 46(3):12–17Google Scholar
  4. 4.
    Lobach DF, Hammond WE (1997) Computerized decision support based on a clinical practice guideline improves compliance with care standards. Am J Med 102(1):89–98.  https://doi.org/10.1016/S0002-9343(96)00382-8 CrossRefPubMedGoogle Scholar
  5. 5.
    Haines A, Donald A (1998) Making better use of research findings. BMJ (Clin Res ed) 317(7150):72–75.  https://doi.org/10.1136/bmj.317.7150.72 CrossRefGoogle Scholar
  6. 6.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655.  https://doi.org/10.1136/bmj.a1655
  7. 7.
    Prior M, Guerin M, Grimmer-Somers K (2008) The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings. J Eval Clin Pract 14(5):888–897.  https://doi.org/10.1111/j.1365-2753.2008.01014.x CrossRefPubMedGoogle Scholar
  8. 8.
    Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE (2012) Knowledge translation of research findings. Implement Sci : IS 7(1):50.  https://doi.org/10.1186/1748-5908-7-50 CrossRefPubMedGoogle Scholar
  9. 9.
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S et al (2010) Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 17(3):CD005470.  https://doi.org/10.1002/14651858.CD005470.pub2
  10. 10.
    Kalies H, Schottmer R, Simon ST, Voltz R, Crispin A, Bausewein C (2017) Critical attitudes and beliefs towards guidelines amongst palliative care professionals—results from a national survey. BMC Palliat Care 16(1):20.  https://doi.org/10.1186/s12904-017-0187-y CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Eysenbach G (2004) Improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 6(3):e34.  https://doi.org/10.2196/jmir.6.3.e34 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kunz A (2005) Leitlinien in der Medizin - Ansichten Berliner Hausärzte (LIMAH) [Clinical practice guidelines: application, attitudes and barriers—a survey of general practicioners in Berlin]. Master Thesis MPH, Freie Universität BerlinGoogle Scholar
  13. 13.
    Hulscher ME, Wensing M, van Der Weijden T, Grol R (2001) Interventions to implement prevention in primary care. Cochrane Database Syst Rev (1):CD000362.  https://doi.org/10.1002/14651858.CD000362
  14. 14.
    Hanbury A, Farley K, Thompson C (2015) Cost and feasibility: an exploratory case study comparing use of a literature review method with questionnaires, interviews and focus groups to identify barriers for a behaviour–change intervention. BMC Health Serv Res 15(1):211.  https://doi.org/10.1186/s12913-015-0877-1 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Krause J, Van Lieshout J, Klomp R, Huntink E, Aakhus E, Flottorp S, Jaeger C, Steinhaeuser J, Godycki-Cwirko M, Kowalczyk A, Agarwal S, Wensing M, Baker R (2014) Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods. Implementation Sci : IS 9(1):102.  https://doi.org/10.1186/s13012-014-0102-3 CrossRefPubMedGoogle Scholar
  16. 16.
    National Institute of Clinical Studies Australia (2006) Identifying barriers for evidence uptake. Melbourne. www.nicsl.com.au
  17. 17.
    Quiros D, Lin S, Larson EL (2007) Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey. Heart Lung : J Crit Care 36(4):287–297.  https://doi.org/10.1016/j.hrtlng.2006.08.005 CrossRefGoogle Scholar
  18. 18.
    Carlsen B, Bringedal B (2011) Attitudes to clinical guidelines-do GPs differ from other medical doctors? BMJ Q Saf 20(2):158–162.  https://doi.org/10.1136/bmjqs.2009.034249 CrossRefGoogle Scholar
  19. 19.
    Ferrier BM, Woodward CA, Cohen M, Williams AP (1996) Clinical practice guidelines. New-to-practice family physicians’ attitudes. Can Fam Phys Med Fam Can 42:463–468Google Scholar
  20. 20.
    Kuronen R, Jallinoja P, Patja K (2011) Use of and attitudes toward current care guidelines among primary and secondary care nurses in Finland. Clin Nurs Res 20(3):310–325.  https://doi.org/10.1177/1054773811407765 CrossRefPubMedGoogle Scholar
  21. 21.
    The American Association for Public Opinion Research (2016) Standard definitions: final dispositions of case codes and outcome rates for surveys. 9th edition. AAPOR, Oakbrook TerraceGoogle Scholar
  22. 22.
    Dobrow MJ, Orchard MC, Golden B, Holowaty E, Paszat L, Brown AD, Sullivan T (2008) Response audit of an internet survey of health care providers and administrators: implications for determination of response rates. J Med Internet Res 10(4):e30.  https://doi.org/10.2196/jmir.1090 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cho YI, Johnson TP, VanGeest JB (2013) Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response. Eval Health Professions 36(3):382–407.  https://doi.org/10.1177/0163278713496425 CrossRefGoogle Scholar
  24. 24.
    Larisch A, Oertel WH, Eggert K (2009) Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice. J Neurol 256(10):1681–1688.  https://doi.org/10.1007/s00415-009-5178-3 CrossRefPubMedGoogle Scholar
  25. 25.
    Butzlaff M, Kempkens D, Schnee M, Dieterle WE, Bocken J, Rieger MA (2006) German ambulatory care physicians’ perspectives on clinical guidelines—a national survey. BMC Fam Pract 7(1):47.  https://doi.org/10.1186/1471-2296-7-47 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hagemeister J, Schneider CA, Barabas S, Schadt R, Wassmer G, Mager G, Pfaff H, Höpp HW (2001) Hypertension guidelines and their limitations—the impact of physicians’ compliance as evaluated by guideline awareness. J Hypertens 19(11):2079–2086.  https://doi.org/10.1097/00004872-200111000-00020 CrossRefPubMedGoogle Scholar
  27. 27.
    Meining A, Driesnack U, Classen M, Rosch T (2002) Management of gastroesophageal reflux disease in primary care: results of a survey in 2 areas in Germany. Zeitschrift fur Gastroenterologie 40(1):15–20.  https://doi.org/10.1055/s-2002-19638 CrossRefPubMedGoogle Scholar
  28. 28.
    Johnson TP, Wislar JS (2012) Response rates and nonresponse errors in surveys. JAMA 307(17):1805–1806.  https://doi.org/10.1001/jama.2012.3532 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Palliative MedicineMunich University HospitalMunichGermany
  2. 2.Center for Palliative MedicineUniversity of CologneKölnGermany
  3. 3.Institute of Medical Informatics, Biometry and Epidemiology (IBE)University of MunichMunichGermany

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