From clinical practice guidelines, to clinical guidance in practice - impacts for computerization

Area of Science:

• Oncology
• Clinical Practice Guidelines
• Health Informatics

Background:

• Clinical practice guidelines (CPGs) are intended to standardize patient care but are often underutilized in real-world clinical settings.
• In oncology, adherence to treatment protocols is crucial for patient outcomes, yet implementation challenges persist.
• Existing CPGs often lack the practical, activity-specific format needed for seamless integration into daily clinical workflows.

Purpose of the Study:

• To investigate the gap between the availability of clinical practice guidelines and their actual application in oncology clinics.
• To explore the effectiveness of transforming CPGs into a more usable format, termed second-order guiding artifacts (SOGAs).
• To understand the role of clinician involvement and artifact design in enhancing the implementation of clinical guidance.

Main Methods:

• A case study methodology was employed within oncology clinics.
• Clinical practice guidelines were analyzed for their application and transformation into SOGAs.
• A standard operating procedure guided the translation and transformation process, incorporating clinician feedback and specific physical design features.
• Clinician participation was central to the development and refinement of the SOGAs.

Main Results:

• Nearly all patients received care aligned with CPGs, but the original guideline documents were seldom directly applied.
• The transformation of CPGs into activity-specific SOGAs, which included relevant documentation spaces, led to their successful application.
• Clinicians actively participated in creating SOGAs, fostering a sense of ownership and improving usability.
• Physical design features of the SOGAs facilitated quick comprehension and application in clinical practice.

Conclusions:

• The direct application of clinical practice guidelines is limited; transformation into context-specific, clinician-developed artifacts is essential for effective implementation.
• Second-order guiding artifacts (SOGAs) offer a viable solution to bridge the gap between guideline recommendations and clinical practice.
• The findings have significant implications for the computerization and design of future clinical decision support systems in oncology and other medical fields.