PDF(Pubmed)
Abstract：
Breast cancer clinical practice guidelines (CPGs) offer evidence-based recommendations to improve quality of healthcare for patients. Suboptimal compliance with breast cancer guideline recommendations remains frequent, and has been associated with a decreased survival. The aim of this systematic review was to characterize and determine the impact of available interventions to support healthcare providers\' compliance with CPGs recommendations in breast cancer healthcare.
We searched for systematic reviews and primary studies in PubMed and Embase (from inception to May 2021). We included experimental and observational studies reporting on the use of interventions to support compliance with breast cancer CPGs. Eligibility assessment, data extraction and critical appraisal was conducted by one reviewer, and cross-checked by a second reviewer. Using the same approach, we synthesized the characteristics and the effects of the interventions by type of intervention (according to the EPOC taxonomy), and applied the GRADE framework to assess the certainty of evidence.
We identified 35 primary studies reporting on 24 different interventions. Most frequently described interventions consisted in computerized decision support systems (12 studies); educational interventions (seven), audit and feedback (two), and multifaceted interventions (nine). There is low quality evidence that educational interventions targeted to healthcare professionals may improve compliance with recommendations concerning breast cancer screening, diagnosis and treatment. There is moderate quality evidence that reminder systems for healthcare professionals improve compliance with recommendations concerning breast cancer screening. There is low quality evidence that multifaceted interventions may improve compliance with recommendations concerning breast cancer screening. The effectiveness of the remaining types of interventions identified have not been evaluated with appropriate study designs for such purpose. There is very limited data on the costs of implementing these interventions.
Different types of interventions to support compliance with breast cancer CPGs recommendations are available, and most of them show positive effects. More robust trials are needed to strengthen the available evidence base concerning their efficacy. Gathering data on the costs of implementing the proposed interventions is needed to inform decisions about their widespread implementation.
CRD42018092884 (PROSPERO).
We searched for systematic reviews and primary studies in PubMed and Embase (from inception to May 2021). We included experimental and observational studies reporting on the use of interventions to support compliance with breast cancer CPGs. Eligibility assessment, data extraction and critical appraisal was conducted by one reviewer, and cross-checked by a second reviewer. Using the same approach, we synthesized the characteristics and the effects of the interventions by type of intervention (according to the EPOC taxonomy), and applied the GRADE framework to assess the certainty of evidence.
We identified 35 primary studies reporting on 24 different interventions. Most frequently described interventions consisted in computerized decision support systems (12 studies); educational interventions (seven), audit and feedback (two), and multifaceted interventions (nine). There is low quality evidence that educational interventions targeted to healthcare professionals may improve compliance with recommendations concerning breast cancer screening, diagnosis and treatment. There is moderate quality evidence that reminder systems for healthcare professionals improve compliance with recommendations concerning breast cancer screening. There is low quality evidence that multifaceted interventions may improve compliance with recommendations concerning breast cancer screening. The effectiveness of the remaining types of interventions identified have not been evaluated with appropriate study designs for such purpose. There is very limited data on the costs of implementing these interventions.
Different types of interventions to support compliance with breast cancer CPGs recommendations are available, and most of them show positive effects. More robust trials are needed to strengthen the available evidence base concerning their efficacy. Gathering data on the costs of implementing the proposed interventions is needed to inform decisions about their widespread implementation.
CRD42018092884 (PROSPERO).
摘要：
背景：乳腺癌临床实践指南（CPGs）提供了以证据为基础的建议，以提高患者的医疗保健质量。对乳腺癌指南建议的次优依从性仍然很常见，并与生存率下降有关。本系统评价的目的是表征和确定可用干预措施的影响，以支持医疗保健提供者在乳腺癌医疗保健中遵守CPG建议。
方法：我们搜索了PubMed和Embase（从成立到2021年5月）的系统评价和初步研究。我们纳入了实验和观察性研究，报告了使用干预措施来支持乳腺癌CPGs的依从性。资格评估,数据提取和批判性评估由一名审阅者进行，并由第二个审阅者交叉检查。使用相同的方法，我们按干预类型综合了干预的特征和效果(根据EPOC分类法)，并应用等级框架来评估证据的确定性。
结果：我们确定了35项主要研究报告24种不同的干预措施。最常描述的干预措施包括计算机化决策支持系统(12项研究)；教育干预措施(7项)，审计和反馈(二)，和多方面的干预措施(九)。有低质量的证据表明，针对医疗保健专业人员的教育干预措施可能会提高对乳腺癌筛查建议的依从性。诊断和治疗。有中等质量的证据表明，医疗保健专业人员的提醒系统可以提高对乳腺癌筛查建议的依从性。有低质量的证据表明，多方面的干预措施可以提高对乳腺癌筛查建议的依从性。已确定的其余干预措施的有效性尚未通过适当的研究设计进行评估。关于实施这些干预措施的成本的数据非常有限。
结论：有不同类型的干预措施来支持乳腺癌CPGs建议的依从性，大多数都表现出积极的影响。需要更有力的试验来加强有关其疗效的现有证据基础。需要收集有关实施拟议干预措施的成本的数据，以告知有关其广泛实施的决定。
背景：CRD42018092884（PROSPERO）。
方法：我们搜索了PubMed和Embase（从成立到2021年5月）的系统评价和初步研究。我们纳入了实验和观察性研究，报告了使用干预措施来支持乳腺癌CPGs的依从性。资格评估,数据提取和批判性评估由一名审阅者进行，并由第二个审阅者交叉检查。使用相同的方法，我们按干预类型综合了干预的特征和效果(根据EPOC分类法)，并应用等级框架来评估证据的确定性。
结果：我们确定了35项主要研究报告24种不同的干预措施。最常描述的干预措施包括计算机化决策支持系统(12项研究)；教育干预措施(7项)，审计和反馈(二)，和多方面的干预措施(九)。有低质量的证据表明，针对医疗保健专业人员的教育干预措施可能会提高对乳腺癌筛查建议的依从性。诊断和治疗。有中等质量的证据表明，医疗保健专业人员的提醒系统可以提高对乳腺癌筛查建议的依从性。有低质量的证据表明，多方面的干预措施可以提高对乳腺癌筛查建议的依从性。已确定的其余干预措施的有效性尚未通过适当的研究设计进行评估。关于实施这些干预措施的成本的数据非常有限。
结论：有不同类型的干预措施来支持乳腺癌CPGs建议的依从性，大多数都表现出积极的影响。需要更有力的试验来加强有关其疗效的现有证据基础。需要收集有关实施拟议干预措施的成本的数据，以告知有关其广泛实施的决定。
背景：CRD42018092884（PROSPERO）。
