Clinicians' attitudes towards Clinical Practice Guidelines in oncology in Australia: a mixed methods study

Clinical Practice Guidelines (CPGs) are a synthesis of the best available evidence, designed primarily to guide treatment decision making. Despite associations between cancer treatment CPG adherent care and enhanced patient outcomes, adherence rates vary widely in Australia. Barriers and facilitators to CPG adherence are well-established; however, little is known specifically about cancer treatment CPG adherence. Greater understanding of context-specific determinants in Australia is warranted to inform local implementation strategies. This thesis presents a mixed methods study that aimed to characterise clinicians’ attitudes towards, perceived barriers to, and facilitators of, cancer treatment CPG adherence in Australia. Two systematic reviews were conducted: the first characterised key barriers and facilitators to cancer treatment CPG adherence, internationally; and the second investigated adherence rates to cancer treatment CPGs in Australia and factors associated with adherence rates. The findings from these systematic reviews supported two empirical studies. The first qualitative phase involved open-ended interviews conducted with oncology specialists in New South Wales, Australia (n=33). Thematic analysis was used to analyse the interview data, which identified five key themes: Theme 1 CPG content; Theme 2 Individual clinician and patient factors; Theme 3 Access to, awareness of, and availability of, CPGs; Theme 4 Organisational and cultural factors; and Theme 5 Development and implementation factors. The findings from these interviews were then used to develop survey questions for the second quantitative phase of the study. Surveys were completed by oncology specialists across Australia (n=48). This phase quantified key barriers and facilitators to adherence and determined whether findings were generalisable among a broader population of oncologists. Findings were integrated, compared and contrasted in a thematic conceptual matrix, highlighting barriers and facilitators that were corroborated by the surveys, and those requiring further investigation to determine generalisability. Key determinants specific to the Australian cancer treatment CPG context were identified, across five themes. These findings informed the development of four key recommendations and associated strategies to guide the development, dissemination and implementation of future cancer treatment CPGs in Australia.