Domain | Barriers |
---|---|
Physical capability | • Lack of updated context-specific clinical practice guidelines to date |
• Existing resource-stratified guidelines (e.g., NCCN Framework™) are not easily accessible | |
• Limited and/or inconsistent resources may affect the ability to follow guidelines | |
Psychological capability | • Providers are not very familiar with existing guidelines |
• Providers are not accustomed to guideline-based practice | |
• Providers do not necessarily believe that they should be following guidelines | |
• More effort is required to reference guidelines than seek (or make) an experience-based decision | |
Physical opportunity | • Guidelines are not part of didactic education or ongoing case-based training |
• The oncologist, resident, and nurse responsible for a patient may not typically be together when a treatment plan is made or changed | |
• Multiple consultants may sequentially assume responsibility for a patient during the treatment course, leading to lack of accountability in patient management | |
• Inefficiencies in clinical systems impede timely completion of standard treatment | |
• Poor communication and coordination among multidisciplinary providers at different institutions | |
Social opportunity | • Clinical norms favor decision-making based on expert opinion and individualized experiences |
• Little professional or organizational value is placed on guideline concordance | |
• Nurses often do not participate in management decision-making | |
• The organizational culture is hierarchical | |
Reflective motivation | • Predominant belief that expertise-based decisions are superior to guidelines |
• Lack of awareness of the clinical benefit of guideline-based practice | |
• Perception that guidelines do not apply to local ORCI setting | |
• Consultants feel that using guidelines stifles professional authority and intellect | |
• Residents and nurses do not feel empowered to question guideline concordance | |
Automatic motivation | • Consultants take pride in expertise and expert-based decisions |
• Residents defer to consultant expertise | |
• Nurses do not routinely evaluate guideline concordance of management decisions | |
• Residents and nurses may fear questioning of management decisions made by consultants | |
• Gap between institutional vision/mission and available resources impacts morale |