Variables influencing adoption of practice-based guidelines in Canadian renal dietetic practice

We sought to determine the variables influencing the adoption of practice-based guidelines by Canadian renal registered dietitians (RRDs) for the identification and treatment of protein-energy malnutrition (PEM) in adult patients with chronic kidney disease on dialysis.

A web-based, cross-country survey was distributed to 288 RRDs via the Canadian Association of Renal Dietitians. The survey consisted of open-ended and close-ended questions addressing variables (facilitators and barriers) influencing RRDs' adoption of evidenced-based practice guidelines (EBPGs), along with questions related to practitioner practice (focused on organization, practitioners, and patients).

Seventy-four (51 full and seven partial) RRDs responded to the survey (for a 25% response rate); 16 responses not meeting the inclusion criteria were excluded from data analysis. Whereas 97% of respondents reported guideline utilization in daily practice, only 24% (n=14) used all of the recommendations within the EBPGs used by RRDs for the identification and treatment of PEM in adults on dialysis. The most commonly cited reasons for using EBPGs were perceived clinical benefits to the patient, and the applicability of guideline recommendations to daily practice. The most common barriers to the adoption of EBPGs were organizational (lack of time or staff and healthcare team support) and practitioner-based (practitioner-perceived conflicts regarding the evidence).

The variables influencing RRDs' adoption of EBPGs were multifactorial (organizationally focused, practitioner-focused, and patient-focused). The development of up-to-date EBPGs for the identification and treatment of PEM in adult patients is urgently needed. The examination of these variables is important to ensure that EBPGs are feasible, applicable, and evidence-based.