Strategies facilitating practice change in pediatric cancer: a systematic review.
OBJECTIVE
By conducting a systematic review, we describe strategies to actively disseminate knowledge or facilitate practice change among healthcare providers caring for children with cancer and we evaluate the effectiveness of these strategies.


METHODS
We searched Ovid Medline, EMBASE and PsychINFO.


METHODS
Fully published primary studies were included if they evaluated one or more professional intervention strategies to actively disseminate knowledge or facilitate practice change in pediatric cancer or hematopoietic stem cell transplantation.


METHODS
Data extracted included study characteristics and strategies evaluated. In studies with a quantitative analysis of patient outcomes, the relationship between study-level characteristics and statistically significant primary analyses was evaluated.


RESULTS
Of 20 644 titles and abstracts screened, 146 studies were retrieved in full and 60 were included. In 20 studies, quantitative evaluation of patient outcomes was examined and a primary outcome was stated. Eighteen studies were 'before and after' design; there were no randomized studies. All studies were at risk for bias. Interrupted time series was never the primary analytic approach. No specific strategy type was successful at improving patient outcomes.


CONCLUSIONS
Literature describing strategies to facilitate practice change in pediatric cancer is emerging. However, major methodological limitations exist. Studies with robust designs are required to identify effective strategies to effect practice change.
Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2.
Paula D
PD
Robinson
Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8.
Lee L
LL
Dupuis
Department of Medicine, 555 University Avenue, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
George
G
Tomlinson
Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Great George Street, Leeds, UK LS1 3EX Centre for Reviews and Dissemination, University of York, York, UK YO10 5DD.
Bob
B
Phillips
Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2 Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8.
Mark
M
Greenberg
Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8.
Lillian
L
Sung
D002648:Child; D006801:Humans; D038622:Internationality; D017146:Models, Organizational; D009369:Neoplasms; D010372:Pediatrics; D010818:Practice Patterns, Physicians'
implementation; knowledge translation; pediatric cancer; quality of care