Abstract：
OBJECTIVE: Androgen deprivation therapy (ADT) is a mainstay of treatment for prostate cancer (PCa) and is associated with increased risks of osteoporosis and fragility fractures. Despite international guidelines to mitigate fracture risk, osteoporosis is under-diagnosed and under-treated due to poor implementation. This scoping review aims to synthesise knowledge surrounding the implementation of guidelines to inform health service interventions to reduce fracture risk in men with PCa-taking ADT (PCa-ADT).
METHODS: Four databases and additional literature were searched for studies published between January 2000 and January 2023. Studies that provided evidence influencing guidelines implementation were included. The i-PARIHS (Promoting Action on Research Implementation in Health Services) implementation framework was used to inform the narrative synthesis.
RESULTS: Of the 1229 studies identified, 9 studies met the inclusion criteria. Overall, an improvement in fracture risk assessment was observed across heterogeneous study designs and outcome measures. Six studies were from Canada. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilised an implementation framework. Implementation barriers included the lack of knowledge for both patients and clinicians, time constraints, unsupportive organisational structures, and challenges in transferring patient care from specialists to primary care. Effective strategies included education, novel care pathways using a multidisciplinary approach, incorporating a healthy bone prescription tool into routine care, point-of-care interventions, and bespoke clinics.
CONCLUSIONS: There is an unmet need to provide evidence-based bone healthcare in men with PCa receiving ADT. This study highlights barriers and strategies in the implementation of fracture risk assessment for PCa-ADT patients.
CONCLUSIONS: Primary care clinicians can play a significant role in the management of complications from long-term cancer treatment such as treatment-induced bone loss. Future studies should consult patients, families, specialists, and primary care clinicians in service re-design.
METHODS: Four databases and additional literature were searched for studies published between January 2000 and January 2023. Studies that provided evidence influencing guidelines implementation were included. The i-PARIHS (Promoting Action on Research Implementation in Health Services) implementation framework was used to inform the narrative synthesis.
RESULTS: Of the 1229 studies identified, 9 studies met the inclusion criteria. Overall, an improvement in fracture risk assessment was observed across heterogeneous study designs and outcome measures. Six studies were from Canada. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilised an implementation framework. Implementation barriers included the lack of knowledge for both patients and clinicians, time constraints, unsupportive organisational structures, and challenges in transferring patient care from specialists to primary care. Effective strategies included education, novel care pathways using a multidisciplinary approach, incorporating a healthy bone prescription tool into routine care, point-of-care interventions, and bespoke clinics.
CONCLUSIONS: There is an unmet need to provide evidence-based bone healthcare in men with PCa receiving ADT. This study highlights barriers and strategies in the implementation of fracture risk assessment for PCa-ADT patients.
CONCLUSIONS: Primary care clinicians can play a significant role in the management of complications from long-term cancer treatment such as treatment-induced bone loss. Future studies should consult patients, families, specialists, and primary care clinicians in service re-design.
摘要：
目的：雄激素剥夺治疗（ADT）是前列腺癌（PCa）的主要治疗方法，与骨质疏松症和脆性骨折的风险增加相关。尽管有减轻骨折风险的国际准则，由于执行不力，骨质疏松症诊断不足和治疗不足。本范围审查旨在综合有关指南实施的知识，以告知卫生服务干预措施，以降低服用PCa的ADT（PCa-ADT）男性的骨折风险。
方法：检索了四个数据库和其他文献，以查找2000年1月至2023年1月之间发表的研究。包括提供影响指南实施的证据的研究。i-PARIHS（促进卫生服务研究实施行动）实施框架被用来为叙事综合提供信息。
结果：在确定的1229项研究中，9项研究符合纳入标准。总的来说,在异质性研究设计和结果测量中,骨折风险评估得到了改善.六项研究来自加拿大。两项研究涉及家庭医生或社区医疗保健计划。两项研究纳入了患者或专家调查。一个人利用了一个实现框架。实施障碍包括患者和临床医生缺乏知识，时间限制,不支持的组织结构，以及将患者护理从专家转移到初级保健的挑战。有效的策略包括教育，使用多学科方法的新型护理途径，将健康的骨骼处方工具纳入常规护理中，即时干预措施，和定制诊所。
结论：在接受ADT的PCa男性中提供基于证据的骨骼保健需求尚未得到满足。本研究强调了PCa-ADT患者实施骨折风险评估的障碍和策略。
结论：初级保健临床医生可以在治疗长期癌症治疗的并发症如治疗引起的骨丢失方面发挥重要作用。未来的研究应该咨询患者，家庭,专家,和初级保健临床医生在服务中重新设计。
方法：检索了四个数据库和其他文献，以查找2000年1月至2023年1月之间发表的研究。包括提供影响指南实施的证据的研究。i-PARIHS（促进卫生服务研究实施行动）实施框架被用来为叙事综合提供信息。
结果：在确定的1229项研究中，9项研究符合纳入标准。总的来说,在异质性研究设计和结果测量中,骨折风险评估得到了改善.六项研究来自加拿大。两项研究涉及家庭医生或社区医疗保健计划。两项研究纳入了患者或专家调查。一个人利用了一个实现框架。实施障碍包括患者和临床医生缺乏知识，时间限制,不支持的组织结构，以及将患者护理从专家转移到初级保健的挑战。有效的策略包括教育，使用多学科方法的新型护理途径，将健康的骨骼处方工具纳入常规护理中，即时干预措施，和定制诊所。
结论：在接受ADT的PCa男性中提供基于证据的骨骼保健需求尚未得到满足。本研究强调了PCa-ADT患者实施骨折风险评估的障碍和策略。
结论：初级保健临床医生可以在治疗长期癌症治疗的并发症如治疗引起的骨丢失方面发挥重要作用。未来的研究应该咨询患者，家庭,专家,和初级保健临床医生在服务中重新设计。
