Clinical Practice Guidelines: The Road Map to Better Care : Rehabilitation Oncology

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Clinical Practice Guidelines: The Road Map to Better Care

Fisher, Mary Insana PT, PhD1

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doi: 10.1097/01.REO.0000000000000324
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Earlier this year, I wrote about the worth of systematic reviews in rehabilitation literature.1 Systematic reviews and meta-analyses are important tools in translating research evidence into clinical practice as they critically evaluate and summarize the body of evidence on clinical topics. Clinicians can use these studies to quickly survey the current literature base to increase understanding of a clinical diagnosis they make, with the intent of using this information to improve their clinical practice. A well-written systematic review or meta-analysis, with critical evaluation of study quality, is then that Cliffs Note version of what to know and what to do. Therefore, with the proliferation of systematic reviews and meta-analyses, we should see a corresponding change in clinical practice, with more effective and more efficient ways to help those with cancer recover function and quality of life. However, in the 2 decades since the Institute of Medicine called on a new health system for the 21st century,2 the translation of evidence into practice still occurs at a snail's pace, with an average lag of 17 years from research publication to clinical adoption.3–5 How then do we move the needle on providing evidence-based care?

Knowledge translation and implementation are helped through the development and publication of quality clinical practice guidelines (CPGs). A CPG takes the systematic review process to the next level by moving from reporting what the literature says to making recommendations for practice based on an extensive review of the literature analyzed by experts in the field. CPGs should be rigorously conducted and meet the following criteria: an extensive and systematic search of the literature on the specific topic; critical analysis of the quality of the included studies; a synthesis and analysis of the cumulative results of those studies; and a clear set of recommendations for clinical practice based on weighing the benefits, harms, and alternatives to care. Experts in the field construct these documents, and important stakeholders give their input on the questions to be answered and the clarity of the documents produced. This process of carefully searching and evaluating the literature, determining risks and benefits, and then synthesizing the quality and findings of the studies with the cumulative risk-to-benefit ratio leads to making recommendations that, when implemented, improve patient care. These qualities are the hallmark of a good CPG.6,7

CPGs, like systematic reviews, are only useful if the conclusions drawn and recommendations made are used in clinical practice. To effect clinical care, a good-quality CPG must be adopted. The primary way to move CPGs into practice is by their incorporation into educational curricula across the spectrum including curriculum for entry-level professional programs, residency training, continuing education courses, and educational resources7 for practicing clinicians. The depth and breadth of the evidence coalesced into a CPG provide definitive recommendations for best practices and only by embedding them into education at all levels, from entry-level to advanced practice, can we move clinical practice forward.

Our Academy (APTA Oncology) has sponsored the development of CPGs for the oncology population. Through the support of APTA, APTA Oncology has completed the third Academy CPG focusing on screening and assessment of cancer-related fatigue (CRF). Published in Physical Therapy and Rehabilitation (DOI link pending), this issue presents the Executive Summary of the CPG for Screening and Assessment of Cancer-Related Fatigue.8 Included are useful tables summarizing best measures for use at different points in the cancer care continuum, with specific cancer populations, and in what languages the tools are available. A figure depicting the decision-making path provides useful algorithm for clinicians. All of these tools are important for successful clinical implementation. This Executive Summary, and the other research reports in this issue, provides useful evidence to improve the rehabilitative care of the individual with cancer. Using CPGs as a road map to better care depends on practicing clinicians and educators; we can only move practice forward by implementing the CPG recommendations.

Just as our profession is moving forward with developing CPGs, Rehabilitation Oncology is moving forward as well. As the official journal of APTA Oncology, we will transition to an online-only journal with the first issue of 2023. This change reflects our fiduciary responsibility to you and our environment by reducing expenses related to the increasing costs of print and reducing use of valuable resources. Readers will still be able to access all of the content in the print version, with an increase in digital pages to publish more relevant research, but will now be available exclusively online at http://www.rehabonc.com.

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REFERENCES

1. Fisher MI. Mountains of evidence. Rehabil Oncol. 2022;40(2):58–59. doi:10.1097/01.REO.0000000000000304.
2. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
3. Trochim W. Translation won't happen without dissemination and implementation: some measurement and evaluation issues. Paper presented at: 3rd Annual Conference on the Science of Dissemination and Implementation; 2010; Bethesda, MD.
4. Green L, Ottoson J, García C, Hiatt R. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health. 2009;30:151–174.
5. Balas E, Boren S. Managing clinical knowledge for health care improvement. In: van Bemmel JH, McCray AT, eds. Yearbook of Medical Informatics. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000:65–70.
6. InformedHealth.org. What Are Clinical Practice Guidelines? Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. https://www.ncbi.nlm.nih.gov/books/NBK390308. Accessed August 3, 2022.
7. Davies C, Levenhagen K, Ryans K, Perdomo M, Gilchrist L. How can a clinical practice guideline enhance my practice? Rehabil Oncol. 2017;35(3):111–113. doi:10.1097/01.REO.0000000000000076.
8. Cohn JC, Harrington SE, Lee JQ, Malone D, Fisher MI. Screening and assessment of cancer-related fatigue: an executive summary and road map for clinical implementation. Rehabil Oncol. 2022;40(4):148–161.
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