Table 1.
Study characteristics, taxonomy strategies used in interventions, and summary of study outcomes
| Study (country) | Study design | Participants | Setting | CPGb | Mazza taxonomy strategies | Outcomesc | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| HCP | Patients | Experimental conditiona | Comparator condition | Primary (HCP level) | Secondary (patient-level) | ||||||
| Aspy et al. [28] (USA) | RCT | Primary care providers | Breast | Outpatient | Screening |
1.5 Educate individual 1.12 Feedback about patients 3.1.1Additional human resources |
No intervention | N/A | + Screening rate | ||
| Ayanian et al. [29] (USA) | RCT | Primary care physicians | Colorectal |
Outpatient Inpatient |
Screening | 1.9 Provide reminders | No intervention | N/A |
+ Test completion + Detection of cancer |
||
| Bertsche et al. [30] (Germany) | QE | Physicians, nurses, pharmacists | Tumour pain | Inpatient | Appropriate symptom management |
1.2 Distribute guideline 1.5 Educate individual 1.12 Feedback about patients 3.3.4 Change in technology |
No intervention |
Antecedent (acceptance of recommendations; N.R.) + Behaviour (deviations from guideline) |
+ Symptom management | ||
| Burack et al. [31] (USA) | RCT | Primary care physicians, internal medicine, gynaecology | Cervical | Outpatient | Screening |
1.9 Provide reminders Patient-directed strategy |
1.9 Provide reminders | No intervention | N/A | Ø Test completion | |
| Carney et al. [32] (USA) | RCT | Radiologists | Breast | Outpatient | Screening - |
1.5 Educate individual 1.11 Feedback guideline compliance 1.12 Feedback about patients 1.15 Other—goal setting |
No intervention | Ø Behaviour (recall rate) | N/A | ||
| Cohn et al. [33] (USA) | QE | Obstetrician-gynaecologists, physicians | Cervical | Outpatient | Screening |
1.2 Distribute guideline 1.3 Advertise guideline 1.5 Educate individual 1.5 Educate individual 1.9 Provide reminders Patient-directed strategy |
1.2 Distribute guideline 1.5 Educate individual 1.5 Educate individual 1.9 Provide reminders |
No intervention |
+ Antecedent (knowledge of guideline) + Antecedent (exposure to guidelines) + Antecedent (patient history) |
N/A | |
| Coleman et al. [34] (USA) | QE | Nurses, physicians, mammography technicians | Breast | Outpatient | Screening |
1.5 Educate individual 1.9 Provide reminders 1.12 Feedback about patients Patient-mediated strategy |
No intervention |
Ø Antecedent (knowledge and attitude) Antecedent (skill; N.R.) |
Ø Screening rate | ||
| Du Pen et al. [35] (USA) | RCT | Oncology nurses, oncologists | Cancer pain | Outpatient | Appropriate symptom management |
1.2 Distribute guideline 1.6 Educate group 1.7 Recruit opinion leader 1.15 Other—algorithm |
1.15 Other—algorithm | + Behaviour (total provider adherence) | + Symptom management (pain outcomes) | ||
| Du Pen et al. [36] (USA) | RCT | Oncology nurses, oncologists | Cancer pain (breast, lung, colorectal, prostate, pancreatic, ovarian, etc.) | Outpatient | Appropriate symptom management |
1.2 Distribute guideline 1.15 Other—algorithm |
No intervention | Behaviour (total provider adherence; N.R.) |
+ Symptom management Ø Quality of life |
||
|
Emery et al. [37] (UK) |
RCT | General practitioners, nurses | Breast, colorectal | Outpatient | Screening |
1.5 Educate individual 1.6 Educate group 1.7 Recruit opinion leader 3.3.4 Change in technology |
1.2 Distribute guideline 1.6 Educate groups |
Antecedent (attitude; N.R.) Antecedent (confidence; N.R.) Antecedent (barriers; N.R.) + Behaviour (screening referral) |
N/A | ||
| Ferreira et al. [38] (USA) | RCT | Physicians, nurses | Colorectal | Outpatient | Screening |
1.6 Educate group 1.11 Feedback guideline compliance 1.12 Feedback about patients 1.14 Feedback from health care professionals Patient-mediated strategy |
No intervention | + Behaviour (screening recommendations) | + Screening rate | ||
| Ganz et al. [39] (USA) | RCT | Primary care providers, nurses, administrative staff | Colorectal | Outpatient | Screening |
1.1 Identify barriers 1.2 Distribute guideline 1.6 Educate group 1.7 Recruit opinion leader 1.9 Provide reminders 1.14 Feedback from health care professionals Patient-directed strategy |
No intervention | Antecedent (uptake of intervention; N.R.) | Ø Screening rate | ||
| Gorin et al. [40] (USA) | RCT | Primary care physicians | Breast | Outpatient | Screening |
1.5 Educate individual 1.6 Educate group 1.9 Provide reminders Patient-directed strategy |
No intervention |
+ Antecedent (knowledge) + Antecedent (perception of barriers) + Behaviour (screening recommendation) |
+ Screening rate | ||
| Hillman et al. [41] (USA) | RCT | Primary care providers |
Breast, cervical, colorectal |
Outpatient | Screening |
1.12 Feedback about patients 2.1.2 Incentive to institution |
No intervention | Ø Behaviour (screening recommendations) | N/A | ||
| Hountz et al. [42] (USA) | QE | Nurses | Colorectal | Outpatient | Screening |
1.6 Educate group 1.11 Feedback guideline compliance 3.3.4 Change in technology Patient-directed strategy |
No intervention | + Behaviour (screenings ordered) | + Test completion | ||
| Kerfoot et al. [43] (USA) | RCT | Primary care physicians, nurses, physician assistants | Prostate | Outpatient | Screening - | 1.11 Feedback guideline compliance | No intervention |
Antecedent (knowledge; N.R) + Behaviour (antigen screening deviations) |
N/A | ||
| Lane et al. [44] (USA) | QE | Primary care physicians | Breast | Outpatient | Screening |
1.5 Educate individual 1.13 Feedback from patients |
No intervention | Ø Behaviour (screening referral) | N/A | ||
| Lane et al. [45] (USA) | RCT | Physicians, nurses, physician assistants | Colorectal | Outpatient | Screening |
1.1 Identify barriers 1.6 Educate group 1.8 Achieve consensus 3.1.2 Reallocated roles 3.1.3 Implementation team |
No intervention | + Behaviour (screening referral) | N/A | ||
| Ling et al. [46] (USA) | RCT | Family practice, internal medicine physicians | Colorectal | Outpatient | Screening |
1.1 Identify barriers 1.6 Educate group 1.10 Provide alerts 3.1.6 Other—development of protocols 3.1.6 Other—changing intervention to facilitate ease of use Patient-directed strategy |
1.10 Provide alerts 1.6 Educate groups 3.1.6 Other—development of protocols Patient-directed strategy |
N/A | + Test completion | ||
| Manfredi et al. [47] (USA) | RCT | Primary care physicians | Breast, cervical, colorectal | Outpatient | Screening |
1.3 Advertise guideline 1.4 Present guideline 1.6 Educate group 1.10 Provide alerts 1.11 Feedback guideline compliance 3.3.5 Change in quality assurance |
1.3 Advertise guideline | N/A | + Test completion | ||
| McDonald et al. [48] (USA) | RCT | Nurses | Cancer pain | Outpatient | Appropriate assessment/instruction practices |
1.2 Distribute guideline 1.3 Advertise guideline 1.9 Provide reminders 3.1.1 Additional human resources |
1.3 Advertise guideline 1.9 Provide reminders |
No intervention | Ø Behaviour (pain assessment) | Ø Symptom management and quality of life | |
| Myers et al. [26, 27] (USA) | RCT | Primary care physicians | Colorectal | Outpatient | Screening |
1.1 Identify barriers 1.6 Educate group 1.9 Provide reminders 1.11 Feedback guideline compliance 1.12 Feedback about patients |
1.9 Provide reminders | + Behaviour (screening) | + Screening rate | ||
| Ornstein et al. [49] (USA) | RCT | Primary care physicians, nurses | Colorectal | Outpatient | Screening |
1.4 Present guideline 1.11 Feedback guideline compliance 1.12 Feedback about patients 1.15 Other—education on ‘best’ implementation strategies 3.1.2 Reallocated roles |
1.4 Present guideline materials 3.12 Reallocated roles |
+ Behaviour (method of screening) | + Test completion | ||
| Patil et al. [50] (India) | QE | Physicians | N.R. | Outpatient | Appropriate symptom management |
1.3 Advertise guideline 1.11 Feedback guideline compliance 3.3.5 Change in quality assurance 4.1 Change in legislation |
No intervention | + Behaviour (physician adherence; prescription overuse) | N/A | ||
| Phillips et al. [51] (Australia) | QE | Nurses | Lung, breast, gynaecological, colorectal, other | Inpatient | Appropriate symptom management |
1.5 Educate individual 1.11 Feedback guideline compliance |
No intervention |
+ Antecedent (knowledge) + Antecedent (confidence) + Behaviour (pain assessment and documentation) |
N/A | ||
| Raj et al. [52] (Norway) | QE | Oncologists | Breast, prostate, colorectal, lymphoma, lung, testicular, anal, upper gastrointestinal, other | Outpatient | Pain management |
1.12 Feedback about patients 3.3.4 Change in technology |
No intervention | Ø Behaviour (prescription) | Ø Symptom management (pain outcomes) | ||
| Rat et al. [53] (France) | RCT | General practitioners | Colorectal | Outpatient | Screening | 1.12 Feedback about patients | 1.11 Feedback guideline compliance | No intervention | + Behaviour (screening) | N/A | |
| Ray-Coquard et al. [54] (France) | QE | Physicians | Breast, colon | Outpatient | Appropriate treatment sequence (screening, procedures, continuity of care) |
1.2 Distribute guideline 1.6 Educate group 1.7 Recruit opinion leader 1.8 Achieve consensus |
No intervention | Behaviour (compliance with CPG; Ø breast; + colon) | N/A | ||
| Ray-Coquard et al. [55] (France) | QE | Physicians | Breast, colon | Outpatient | Appropriate treatment sequence (screening, procedures, continuity of care) |
1.2 Distribute guideline 1.6 Educate group 1.8 Achieve consensus |
No intervention | + Behaviour (compliance with CPG) | N/A | ||
| Roila et al. [56] (Italy) | RCT | Oncologist | Breast, lung, ovary, colorectal, other | Inpatient | Appropriate symptom management |
1.2 Distribute guideline 1.6 Educate group 1.11 Feedback guideline compliance |
1.2 Distribute guideline 1.11 Feedback guideline compliance |
1.2 Distribute guideline | + Behaviour (prescription) | N/A | |
| Sequist et al. [57] (USA) | RCT | Primary care physicians | Colorectal | Outpatient | Screening |
1.9 Provide reminders Patient-mediated strategy |
1.9 Provide reminders | Patient-mediated strategy | No intervention | Antecedent (attitude; N.R.) |
Ø Screening rate + Detection of cancer |
| Walsh et al. [58] (USA) | RCT | Primary care physicians | Colorectal | Outpatient | Screening |
1.1 Identify barriers 1.5 Educate individual 1.6 Educate group 1.7 Recruit opinion leader Patient-mediated strategy |
1.6 Educate groups | N/A | Ø Screening rate | ||
| Wright et al. [67] (Canada) | RCT | Physicians | Colon | Outpatient | Accuracy of diagnosis |
1.5 Educate individual 1.6 Educate group 1.7 Recruit opinion leader 1.9 Provide reminders |
1.6 Educate groups | Ø Behaviour (staging) | N/A | ||
CPG clinical practice guideline, HCP health care professional, N/A not measured in study so not applicable, N.R. measured in study but not reported, QE quasi-experimental, RCT randomized controlled trial, UK United Kingdom, USA United States of America
aWhere there are two sets of strategies it indicates the presence of multiple experimental groups within a study; where strategies are repeated it indicates the coding of the same strategy in two distinct components of the intervention
bDirection of the recommendation is to increase behaviour, with the exception of one study as indicated with ‘–‘
c‘+’represents positive and significant changes and a ‘Ø’ represents a null finding