Bridging Operative Standards to Clinical Practice: A Case Comparison of Synoptic Operative Report Implementation in...

In 2020, the Commission on Cancer (CoC) announced a new accreditation standard requiring use of synoptic operative reporting (SOR) to improve the proportion of patients with breast cancer receiving guideline concordant care. We conducted a case-comparison of four CoC accredited sites' implementation of breast SOR to identify ways in which the CoC could address common implementation challenges.

We conducted semi-structured interviews from December 2021 to May 2022 with 31 stakeholders purposefully sampled from two NCI-Designated Cancer Programs and two Comprehensive Community Cancer Programs in the US. We used the Consolidated Framework for Implementation Research to guide thematic analysis and identify similarities and differences between cases.

All cases expressed that the CoC was the driver for SOR implementation, had concerns about complexity and costs, and noted that the cancer liaison physician and information technology are critical during implementation. Sites noted that surgeons who dictate had challenges changing workflows to accommodate SORs. All sites believed standardization and data collection via SORs were beneficial but not essential, leading to low tension for change. Informatics support and clinician expertise with information technology varied by site, affecting the ability to translate clinical requirements for SOR integration.

Cancer liaison physicians were a critical champion across all settings, underscoring the importance of the CoC's continued engagement with this role. To reduce cost and complexity of developing SORs and account for varying clinical informatics knowledge and resources, the CoC should consider providing additional tailored technical support.