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Knowledge Translation Interventions to Address Gaps in Rectal Cancer Care
Erin D Kennedy1,2,3, Amandeep Pooni2,4, Selina Schmocker3
1Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Importance:
Over the last 2 decades, increasing use of multimodal strategies has led to significant improvements in oncologic outcomes for patients with rectal cancer. However, uptake of these strategies varies among centers, suggesting that best evidence is not always implemented into practice.
Objectives:
To identify gaps in care and initiate knowledge translation interventions to close existing gaps.
Design, Setting, And Participants:
This 3-year multifaceted, prospective quality improvement study was conducted at 8 high-volume rectal cancer centers across Canada. From April 2016 to December 2018, patients with stage I to III rectal cancer undergoing total mesorectal excision were enrolled. Data were analyzed from January 2022 through December 2023.
Interventions:
Process measures for multimodal strategies to optimize rectal cancer care were selected and prospectively collected for patients with stage I to III rectal cancer undergoing total mesorectal excision. Knowledge translation interventions were implemented to increase uptake of these strategies.
Main Outcome And Measure:
Change in uptake of process measures over the study period, with measures taken every 3 months, from time 1 (baseline) to time 7 (18 months).
Results:
Among 645 patients with stage I to III rectal cancer (389 male [60.3%]; mean [SD] age, 68.1 [8.2] years), iterative results showed that uptake of 6 of 12 process measures (eg, presentation at multidisciplinary cancer conference: 22 of 77 patients [28.6%] at time 1 to 64 of 91 patients [70.3%] at time 7; P < .001) and 1 pathology measure (inadequate lymph node retrieval: 15 of 77 patients at time 1 [19.5%] to 6 of 91 patients at time 7 [6.6%]; P = .002) improved over time. Positive circumferential resection margin, positive distal margin, and inadequate lymph node retrieval rates at 2 years were 44 patients (6.8%), 10 patients (1.6%), and 79 patients (12.2%), respectively.
Conclusions And Relevance:
In this study, there was an improvement in 6 process measures and 1 pathology measure for patients with stage I to III rectal cancer. Furthermore, this study led to standardized processes of care for rectal cancer that may facilitate continuous quality improvement and multicenter trials across Canada.
Insights
Implementing multimodal strategies improved rectal cancer care by increasing the uptake of key process measures and pathology standards. This quality improvement initiative standardized care across Canadian centers.
Area of Science:
- Oncology
- Surgical Oncology
- Quality Improvement
Background:
- Multimodal strategies have improved rectal cancer outcomes over two decades.
- Varied implementation of these strategies across centers highlights gaps in evidence-based practice.
Purpose of the Study:
- To identify care gaps in rectal cancer treatment.
- To implement knowledge translation interventions to improve adherence to best practices.
Main Methods:
- A 3-year prospective quality improvement study at 8 Canadian centers.
- Involved patients with stage I-III rectal cancer undergoing total mesorectal excision.
- Prospective data collection on process measures and knowledge translation interventions.
Main Results:
- Uptake of 6 of 12 process measures (e.g., multidisciplinary conference presentation) significantly improved (28.6% to 70.3%).
- Inadequate lymph node retrieval decreased significantly (19.5% to 6.6%).
- Positive margins and inadequate lymph node retrieval rates at 2 years were 6.8%, 1.6%, and 12.2% respectively.
Conclusions:
- The study demonstrated improvement in key process and pathology measures for rectal cancer care.
- Standardized care processes were established, facilitating continuous quality improvement.
- This initiative may support future multicenter trials in Canada.
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