Barriers and Facilitators in Application of the Living Guideline Framework in Oncology–A Mixed Methods Study

Article type
Authors
Ismaila N1, Harvey B2, Einhaus K2, Mbuagbaw L3, Ma J2, Thabane L4
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; American Society of Clinical Oncology, Alexandria, Virginia, United States
2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
4Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, Johannesburg, South Africa
Abstract
Background: Living guidelines (LGs) have been proposed as the solution to the challenge of keeping up with the rapid pace of evidence generation. A framework for creating and maintaining these LGs has been developed. However, the practical application of this LG framework is yet to be evaluated in oncology guidelines. Identifying potential barriers or facilitators could inform a need for modification of the framework for future use.

Objectives: To identify barriers and facilitators to the application of the LG development framework and discuss approaches to overcome these barriers.

Methods and Analysis Plan: An exploratory sequential mixed methods approach will be used. This study design offers a holistic approach to research by combining the strengths of qualitative and quantitative methods to provide a more thorough and nuanced understanding of complex research question. The first part of the study is the qualitative phase which will involve in-depth interviews with experts who have rich experience in LG development in oncology (6-10 participants). The themes identified from results from this phase will be used to develop a survey tool. The second quantitative phase will involve a cross sectional survey administered to a larger sample of individuals involved in LG development to generalize findings (n=132). A thematic analysis of the qualitative data and a binary logistic regression of the quantitative data will be completed to identify the barriers or facilitators that are associated with the application of the LG development framework. Successful completion of LGs using the LG framework will be explored as the binary independent variable, while factors identified as barriers or facilitators to the use of the LG framework will serve as potential independent variables. Data from both phases will be merged.

Relevance and Importance: Having a structured process for LG development is essential for consistency amongst guideline developers and provides a more reliable product for end-users. Identifying barriers and facilitators to the application of the LG development framework is important in evaluating its usability.