title: Diffusion of a Distress Management Guideline into practice.
abstract: OBJECTIVE
  The purpose of this study was to explore system and clinician-related barriers, and predictors for the adoption of the National Comprehensive Cancer Network Distress Management Guideline (DMG) into oncology outpatient practice.
  
  
  METHODS
  This descriptive, correlational study surveyed a national sample of oncology nurses working in an outpatient setting who completed the survey electronically or by mail.
  
  
  RESULTS
  Study respondents (n = 409) were predominantly certified nurses (84%) yet largely unfamiliar with the DMG; 17% of respondents were using the DMG. Time, staff uncertainties and ambiguous accountability were the largest barriers to not assessing distress. Compared with those not using any assessment tool, those using the DMG were more comfortable discussing distress, worked as an oncology nurse longer, scored colleagues higher on valuing distress screening and had more organizational processes in place to support evidence-based practices. Significant predictors of DMG use included higher familiarity with the DMG (OR 3.81, p < .001), lower perceived barriers (OR 0.41, p = .001), non-profit status (OR 3.93, p = .05) and urban or rural (versus suburban) work settings (OR 04.59, p = .04; overall model chi-square 133.25, df 12, p < .001, Nagelkerke R(2) .67).
  
  
  CONCLUSIONS
  This study identified barriers and predictors to using the DMG, which are amenable to interventions. DMG adoption may be augmented by interventions, which increase familiarity with the guideline. Additionally, adoption of the DMG may improve through explicit articulation of the responsibilities oncology team members have in cancer-related distress screening and management. Further studies are needed to evaluate the efficacy of such interventions and their impact on patient care outcomes.
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Tavernier
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
authors.affiliation: Piedmont Research Strategies, Summerfield, USA.
authors.forename: William N
authors.initials: WN
authors.lastname: Dudley
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D001007:Anxiety / Q000628:therapy*; D001291:Attitude of Health Personnel; D003863:Depression / Q000628:therapy*; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000458:organization & administration; D009369:Neoplasms / Q000523:psychology*; D009859:Oncology Nursing / Q000379:methods* / Q000458:organization & administration; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: cancer; clinical practice guideline; distress; nursing; oncology; research; translational