Systematic review of quality-improvement interventions aimed at cancer specialists — ASN Events
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Systematic review of quality-improvement interventions aimed at cancer specialists (#846)

Michael Coory 1 , Victoria White 2 , Kristin Johnson 2 , David J Hill 2 3 , Michael Jefford 2 3 4 , Simon Harrison 5 6 , Ingrid Winship 3 7 , Jeremy Millar 8 9 , Graham Giles 2
  1. Murdoch Children’s Research Institute , Royal Children's Hospital, Melbourne, VIC, Australia
  2. Cancer Council Victoria, Melbourne, VIC, Australia
  3. Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, VIC, Australia
  4. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  5. Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
  7. The Royal Melbourne Hospital, Melbourne, VIC, Australia
  8. Radiation Oncology, Alfred Health, Melbourne, VIC, Australia
  9. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Background: Despite the recent emphasis on reducing practice and outcome variation through more effective teamwork, quality improvement interventions (QIIs) aimed at cancer specialists are needed because there are some processes over which only cancer specialists have control (e.g. surgical technique, optimisation of chemotherapy regimen). There is a need to identify which, if any, QIIs are effective with cancer specialists.


Methods: Medline, PsycINFO, CINAHL and EMBASE searches were conducted for studies of QIIs aimed at cancer specialists, published between January 1990 and April 2012. Papers were excluded if they focused on financial interventions, multidisciplinary care or did not involve direct care of patients (e.g., pathology reporting). All study designs were included.


Findings: A total of 5781 unique English-language papers were identified and of these 13 meet the study’s eligibility criteria. Three papers reported results from cluster-randomised controlled trials (cRCT), seven reported on uncontrolled before and after studies and three reported results from cross-sectional studies. No cRCTs showed a benefit of the QIIs they tested. While some of the uncontrolled before and after and cross-sectional studies reported benefits of QII, these studies are difficult to interpret because they are prone to publication bias. Interventions in all studies were multifaceted, but descriptions of different components were limited and only one study examined their separate impact using a multi-arm trial design.


Interpretation: Although there is demonstrable need to reduce variation in the care provided to cancer patients, the published evidence regarding how to do this is thin. The evidence that has been published is difficult to interpret because of the potential for publication bias and lack of documentation about the components of the intervention. More investment in research to develop and assess QIIs for cancer specialists is needed to ensure consistent adoption of new clinical knowledge into everyday clinical practice.