Table 4 Logic model for implementation of guideline-based clinical practice at ORCI

Staff

 • Project leaders (ORCI/UCSF)

 • Co-Investigators (ORCI/UCSF)

 • Implementation Champions (ORCI)

 • Research Coordinators (MUHAS)

 • Research Consultants (MUHAS/UCSF)

Materials

 • Hard copies of guidelines

 • Soft copies of guidelines (AgileMD)

 • Publicity materials (flyers, texts)

 • ORCI-specific DST forms

 • Training materials

 • Hard and soft copies of questionnaires

 • Data collection forms for observation

Experience and expertise

 • Training and consultation in implementation science and program evaluation

 • Consultation with biostatistician for questionnaire design and analysis

 • Experience implementing clinical protocols and DST forms at a different regional site

 • Existing MUHAS/ORCI/UCSF Cancer Collaboration infrastructure and experience

Distribution of materials

 • Hard copies to every unit and clinic room

 • Soft copies to every provider via smartphone application (AgileMD)

 • Publicity campaign with flyers and texts

Education and training

 National Guideline Training Summit:

  • Raise awareness of international efforts to develop resource-stratified guidelines

  • Teach providers guideline content and benefits of guideline-based practice

  • Train providers in guideline-based practice, DST completion, documentation of rationale for treatment decisions

  • Train Champions to promote guideline-based practice on an ongoing basis

  • Integrate guidelines into existing training curricula

Environmental restructuring

 • Champions will model and promote guideline-based practice

 • Integration of DST forms into clinical workflow

 • Assignment of one consultant per patient for greater accountability

 • Monthly forum to evaluate implementation and “safe space” to discuss deviations

Short-term

 • Increased knowledge of guidelines and skills in guideline-based practice among providers

 • Proficiency in completing DSTs

 • Shift in attitudes and beliefs toward preference for guidelines over individual experience and expertise

 • Increased comfort to ask peers and superiors about guideline concordance of treatment plans

Medium-term

 • Increase in clincial decision-making based on guidelines

 • Routine completion of DSTs

 • Routine reference to guidelines in case discussions at conference

 • Increase in rates of guideline-concordant treatment plans made

 • Increase in rates of guideline-concordant treatment plans completed

Long-term

 • Increase in cancer survival outcomes

 • Increase in palliative benefit and quality of life

 • Improved resource utilization