Barriers to the implementation of new guidelines among pediatric surgeons: online survey

Abstract

Purpose

To identify barriers that prevent pediatric surgeons from implementing updated practice guidelines.

Methods

An online survey targeting pediatric surgeons was conducted on the StayCurrent MD Application (SCMA) and Pediatric Surgery Education Facebook page (PSE FBP). The survey results for pediatric surgeons of underdeveloped countries (PSUC) and pediatric surgeons of developed countries (PSDC) was compared and analyzed.

Results

Based on the number of active members on PSE FBP and SCA, the response rate was 32.3% (174/539), 66.3% of responses were from PSUC. The majority of PSUC (73%) wanted to have convincing guidelines and the plurality of PSDC (46%) wanted to see approval by the American Pediatric Surgical Association (APSA) for implementation of new guidelines. Lack of resources was the number one response (78%) for PSUC not implementing the most up to date guidelines and about 40% of the PSDC responded “concerned about malpractice liability.”

Conclusions

PSUC and PSDC identified very different barriers to implementation of new guidelines. It is reassuring that accessibility to treatment is not the primary issue, though resistance to implementation is a resounding concern. Identifying the barriers will highlight areas that need to be addressed, and awareness may help resolve some of the barriers.

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Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AL, AG, SW, and TP. The first draft of the manuscript was written by AL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Abdulraouf Lamoshi.

Ethics declarations

Conflict of interest

First author, Abdulraouf Lamoshi, declares that he has no conflict of interest. Second author, Alexander Gibbons, declares that he has no conflict of interest. Third author, Sonja Williams, declares that she has no conflict of interest. Senior author, Todd Ponsky, declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study (survey).

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Appendix 1

Appendix 1

Barriers to the implementation of new guidelines among pediatric surgeons questionnaire

  1. 1.

    How many years of experience do you have as a pediatric surgeon?

  2. 1.

    1–3.

  3. 2.

    4–6.

  4. 3.

    7–10.

  5. 4.

    > 10.

  1. 2.

    What is your gender?

  2. 1.

    Male.

  3. 2.

    Female.

  4. 3.

    I would rather not say.

  1. 1.

    What is your country of practice?

  1. 3.

    Hospital affiliation?

  2. 1.

    Academic.

  3. 2.

    Private.

  4. 3.

    Community.

  5. 4.

    How do you keep up to date with changing guidelines, recommendations and protocols? (Check all that apply).

  1. 1.

    Reading journals regularly.

  2. 2.

    Attending national meetings.

  3. 3.

    Institutional weekly academic conferences.

  4. 4.

    Other.

  5. 5.

    None of the above.

  1. 5.

    What evidence would like to see to adopt and implement? (Check all that apply).

  2. 1.

    Level 1 evidence study.

  3. 2.

    Published by APSA.

  4. 3.

    Accepted by your team.

  5. 4.

    Convincing/appealing for you.

  1. 6.

    Do you implement the most update guidelines, recommendations, and protocols in your daily practice?

  2. 1.

    Yes.

  3. 2.

    No.

  4. 3.

    Somewhat.

  1. 7.

    If No or somewhat, what is/are the reasons? (Check all that apply).

  2. 1.

    Lack of resources.

  3. 2.

    Lack of awareness.

  4. 3.

    Lack of agreement regarding content.

  5. 4.

    Concerns about malpractice liability.

  6. 5.

    Lack of experience with the new protocol/procedure.

  1. 8.

    Can you think of any other barriers that would prevent you from implementing the most up to date guidelines, protocols, or recommendations?

  1. 9.

    . Which of the following resource barriers stops you from implementing the updated guidelines?

  2. 1.

    Treatment guidelines are hard to implement in daily practice due to lack of medical resources (investigational abilities, etc.)

  3. 2.

    Treatment guidelines are hard to implement in daily practice due to a lack of resources of patients (expensive medicines, etc.)

  4. 3.

    There is no time to search for information

  5. 4.

    None.

  1. 10.

    Which of the following system barriers stops you from implementing the updated guidelines?

  2. 1.

    Treatment guidelines are not accessible.

  3. 2.

    Treatment guidelines are too complicated and it is difficult to find the information

  4. 3.

    None

  1. 11.

    Which of the following attitudinal barriers stops you from implementing the updated guidelines?

  2. 1.

    Treatment guidelines reduce doctors’ autonomy (a ‘cookbook’)

  3. 2.

    Treatment guidelines limit treatment options

  4. 3.

    Treatment guidelines limit flexibility and individual approach

  5. 4.

    There is no need for treatment guidelines as treatment routines exist

  6. 5.

    None

  1. 12.

    Which of the following patient barriers stops you from implementing the updated guidelines?

  2. 1.

    Patients do not want doctors to conform to treatment guidelines

  3. 2.

    None

  1. 13.

    What can help you overcome the barriers?

  2. 1.

    An easy-to-find online database

  3. 2.

    Special training courses

  4. 3.

    Published materials

  5. 4.

    Information through professional societies

  6. 5.

    Available consultation to answer questions about the guidelines

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Lamoshi, A., Gibbons, A., Williams, S. et al. Barriers to the implementation of new guidelines among pediatric surgeons: online survey. Pediatr Surg Int (2020). https://doi.org/10.1007/s00383-020-04707-y

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Keywords

  • Barriers
  • Implementation
  • Updated
  • Guidelines
  • Pediatric surgery