Dissemination, implementation and impact of the ESHRE evidence-based guidelines

What are the perceptions of ESHRE members about the dissemination, implementation and impact of the first four ESHRE evidence-based guidelines to be published?

Around 30% of ESHRE members know and use the ESHRE evidence-based guidelines in their routine practice and this is perceived to result in better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care, with on average three in each four members who make changes perceiving that their patients benefit from it.

ESHRE has been developing and disseminating evidence-based guidelines, aiming to improve the quality of fertility care across Europe. However, evidence has shown that guidelines dissemination is not enough to change practice at clinics, with implementation strategies that address local barriers to implementation being recommended.

A cross-sectional study based on an online survey was sent by email to all ESHRE members (n = 7664) and advertised on ESHRE social media (20 February-3 April 2018). The survey was carried out to evaluate their perceptions about the dissemination, implementation and impact of the Management of Endometriosis (ENDO), Routine Psychosocial Care (RPC), Premature Ovarian Insufficiency (POI) and Recurrent Pregnancy Loss (RPL) ESHRE guidelines.

The survey was advertised via the ESHRE website, social media and email to all ESHRE members. It assessed the dissemination (knowledge the guidelines were published, downloaded), implementation (using guidelines in daily practice, changed practice) and impact (perceived patient benefit, referred patients to the guidelines) of the guidelines, as well as their perceived implementability. Open questions assessed perceived changes in practice, barriers to and desired support for implementation.

The final sample consisted of 658 participants (not possible to calculate response rate), with the majority being embryologists, biologists or geneticists (n = 268, 40.7%), followed by clinicians (n = 260, 39.5%), scientists (n = 48, 7.3%), nurses or midwives (n = 30, 4.6%), psychologists, counsellors or social workers (n = 28, 4.3%) and others (e.g. medical student, lab manager, marketing, ethicist; n = 24, 3.6%). The majority knew that ESHRE published the guidelines (82.1% ENDO, 54.6% RPC, 56.6% POI, 59.4% RPL). From these, the majority downloaded it (65.9% ENDO, 52.4% RPC, 54.2% POI, 56.8% RPL), around one-third used it in their routine practice (41.7% ENDO, 29.5% RPC, 33.7% POI) and around one quarter made changes to their practice (30.7% ENDO, 18.9% RPC, 21.5% POI). Overall, <20% of members think that patients benefited from the guideline (19.4% ENDO, 16.3% RPC, 16.1% POI) and very few referred them to it (ENDO 8.9%, 12.8% RPC, 16.1% POI). However, on average every three in every four people who made changes to practice perceived that their patients benefited from it (ENDO 62%, RPC 80%, POI 75%). The main reported changes in practice were better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care. Main perceived barriers to implementation were lack of translation to other languages, guidelines being long and difficult to understand and lack of supporting evidence. Financial constraints and lack of staff expertise were also reported. Participants desired clear support for implementation in the form of step-by-step instructions, more training and support materials for staff and patients and translation to other languages. Results for the clinicians only showed that, despite less knowledge about the RPC guideline, they were more likely to download all the guidelines, to follow them, make changes in their daily practice and refer them to their patients.

Respondents were ESHRE members and these are not representative of all European reproductive health professionals. The response rate could not be calculated as ESHRE social media reaches more than just the members. The guidelines are mainly written for clinicians and in this sample the clinicians were under-represented. In addition, missing values increased as participants progressed through each guideline's questions, with the open-ended questions being answered by only 74-97 participants. The survey assessed perceptions instead of actual practice. Overall, the results may convey a too optimistic picture of the impact of the guidelines.

ESHRE's policy of investing in implementation and dissemination is important but insufficient to ensure the guidelines are implemented at clinics across Europe. ESHRE can address perceived barriers that are directly related to the guidelines, in particular lack of translation, as well as provide further support for implementation. This support should be clear and concise, focusing on how to implement the guidelines rather than on what to do.

None.