학술논문
Factors Influencing Implementation of the Commission on Cancer's Breast Synoptic Operative Report (Alliance A20_Pilot9).
Document Type
Academic Journal
Author
Park KU; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. kpark16@bwh.harvard.edu.; Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA. kpark16@bwh.harvard.edu.; Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA. kpark16@bwh.harvard.edu.; Harvard Medical School, Boston, MA, USA. kpark16@bwh.harvard.edu.; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA. kpark16@bwh.harvard.edu.; Padamsee TJ; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.; Birken SA; Wake Forest University School of Medicine, Winston-Salem, NC, USA.; Lee S; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.; Niles K; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.; Blair SL; University of California San Diego, La Jolla, CA, USA.; Grignol V; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.; Dickson-Witmer D; Beebe Healthcare, Rehoboth Beach, DE, USA.; Nowell K; Physicians' Clinic of Iowa, Cedar Rapids, IA, USA.; Neuman H; School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.; King T; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Mittendorf E; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Paskett ED; James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.; Brindle M; Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Source
Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The technical aspects of cancer surgery have a significant impact on patient outcomes. To monitor surgical quality, in 2020, the Commission on Cancer (CoC) revised its accreditation standards for cancer surgery and introduced the synoptic operative reports (SORs). The standardization of SORs holds promise, but successful implementation requires strategies to address key implementation barriers. This study aimed to identify the barriers and facilitators to implementing breast SOR within diverse CoC-accredited programs.
Methods: In-depth semi-structured interviews were conducted with 31 health care professionals across diverse CoC-accredited sites. The study used two comprehensive implementation frameworks to guide data collection and analysis.
Results: Successful SOR implementation was impeded by disrupted workflows, surgeon resistance to change, low prioritization of resources, and poor flow of information despite CoC's positive reputation. Participants often lacked understanding of the requirements and timeline for breast SOR and were heavily influenced by prior experiences with templates and SOR champion relationships. The perceived lack of monetary benefits (to obtaining CoC accreditation) together with the significant information technology (IT) resource requirements tempered some of the enthusiasm. Additionally, resource constraints and the redirection of personnel during the COVID-19 pandemic were noted as hurdles.
Conclusions: Surgeon behavior and workflow change, IT and personnel resources, and communication and networking strategies influenced SOR implementation. During early implementation and the implementation planning phase, the primary focus was on achieving buy-in and initiating successful roll-out rather than effective use or sustainment. These findings have implications for enhancing standardization of surgical cancer care and guidance of future strategies to optimize implementation of CoC accreditation standards.
(© 2024. The Author(s).)
Methods: In-depth semi-structured interviews were conducted with 31 health care professionals across diverse CoC-accredited sites. The study used two comprehensive implementation frameworks to guide data collection and analysis.
Results: Successful SOR implementation was impeded by disrupted workflows, surgeon resistance to change, low prioritization of resources, and poor flow of information despite CoC's positive reputation. Participants often lacked understanding of the requirements and timeline for breast SOR and were heavily influenced by prior experiences with templates and SOR champion relationships. The perceived lack of monetary benefits (to obtaining CoC accreditation) together with the significant information technology (IT) resource requirements tempered some of the enthusiasm. Additionally, resource constraints and the redirection of personnel during the COVID-19 pandemic were noted as hurdles.
Conclusions: Surgeon behavior and workflow change, IT and personnel resources, and communication and networking strategies influenced SOR implementation. During early implementation and the implementation planning phase, the primary focus was on achieving buy-in and initiating successful roll-out rather than effective use or sustainment. These findings have implications for enhancing standardization of surgical cancer care and guidance of future strategies to optimize implementation of CoC accreditation standards.
(© 2024. The Author(s).)