Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines

Elizabeth Campione; Meredith Wampler; Charlotte A Bolch; Joseph J Krzak

doi:10.1007/s11764-023-01475-1

Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines

J Cancer Surviv. 2023 Oct 18. doi: 10.1007/s11764-023-01475-1. Online ahead of print.

Authors

Elizabeth Campione¹, Meredith Wampler², Charlotte A Bolch³, Joseph J Krzak⁴

Affiliations

¹ Physical Therapy Program, Midwestern University, Downers Grove, IL, USA. ecampi@midwestern.edu.
² Program in Physical Therapy, Oregon State University - Cascades, Bend, OR, USA.
³ Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA.
⁴ Physical Therapy Program, Midwestern University, Downers Grove, IL, USA.

PMID: 37853271
DOI: 10.1007/s11764-023-01475-1

Abstract

Purpose: The purpose of this study was to identify barriers and facilitators influencing implementation of the diagnosis and intervention clinical practice guidelines (CPGs) related to the management of patients with breast cancer-related lymphedema (BCRL).

Methods: A descriptive, cross-sectional web-based survey was conducted. Participants included physical therapists and assistants who were members of the APTA's Academy of Oncologic Physical Therapy and Lymphology Association of North America. Desriptive statisitcs were computed for all demographic and barriers and facilitators data. Individual exploratory factor analyses (EFA) were performed on survey items for both CPGs to identify themes of barriers and facilitators to implementation.

Results: A total of 180 respondents completed the survey. 34.9% of respondents read the diagnosis CPG and 22.4% read the intervention CPG. A total of 77.8% reported that they did not have issues in changing their clinical routines and 69.5% did not have resistance working according to CPGs. The EFA resulted in 3 themes for each CPG, accounting for 46% of the variance for the diagnostic CPG and 54% of the variance for the intervention CPG. The 3 themes, clinician characteristics, patient demographics, therapist practice setting and beliefs/values, were weighted differently for each EFA.

Conclusion: Most respondents did not read either CPG, however, report a willingness to make changes to clinical practice and utilization of CPGs. For those who have attempted to implement the CPGs, this study was the first to identify the barriers and facilitators impacting the implementation of the CPGs related to the management of BCRL.

Implications for cancer survivors: The results will inform the development of targeted implementation strategies to improve access to and adherence to recommendations from the CPGs ultimately improving the efficiency and efficacy of care delivery to patients.

Keywords: Barriers; Breast cancer-related lymphedema; Clinical practice guidelines; Facilitators.