title: Adherence to and uptake of clinical practice guidelines: lessons learned from a clinical practice guideline on chemotherapy concomitant with radiotherapy in head-and-neck cancer.
abstract: BACKGROUND
  Clinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly.
  
  
  METHODS
  An assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003-2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg.
  
  
  RESULTS
  In 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer; however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2-4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with "higher" and "lower" use of ccrt, no difference in survival was observed (p = 0.64).
  
  
  CONCLUSIONS
  At a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines.
authors.affiliation: Department of Otolaryngology, Queen's University, Kingston, ON. ; Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON.
authors.forename: S F
authors.initials: SF
authors.lastname: Hall
authors.affiliation: Department of Otolaryngology, Queen's University, Kingston, ON. ; Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.
authors.forename: J C
authors.initials: JC
authors.lastname: Irish
authors.affiliation: Department of Oncology, Queen's University, Kingston, ON.
authors.forename: R W
authors.initials: RW
authors.lastname: Gregg
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON.
authors.forename: P A
authors.initials: PA
authors.lastname: Groome
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON.
authors.forename: S
authors.initials: S
authors.lastname: Rohland
keywords: Clinical practice guidelines; chemoradiotherapy; head-and-neck cancer; uptake; variation