Identification of barriers and facilitators in nationwide implementation of standardized structured reporting among multidisciplinary team members: a qualitative study

Abstract

Introduction: Standardized structured reporting (SSR) improves the quality of diagnostic reporting for cancer patients, resulting in improved patient health outcomes and patient safety. However, the use of standardized templates varies widely among medical disciplines. Therefore, we aim to identify both barriers and facilitators that multidisciplinary team (MDT) members, discussing the policy for cancer patients in hospitals, encounter in SSR, especially in pathology reporting, in order to develop tailored implementation tools to encourage SSR. Methods: We used a qualitative design. Four focus group interviews were performed in different types of hospitals to identify barriers and facilitators of SSR among MDT members, operating in the field of urological, gynecological or gastrointestinal oncology. Additionally, we performed a focus group with PALGA liaisons to identify technical barriers and facilitators of SSR. The findings were classified into the domains: innovation, individual professional, social setting, organization, and economic and political context. Results: Twenty-five MDT members of nine medical disciplines and nine PALGA liaisons participated in the focus group interviews. Main barriers of SSR were lack of compliance with the need of information during MDT meetings, such as lack of nuance and conflicting conclusions in the pathology report; lack of corresponding information systems and lack of nationwide regulations regarding SSR. Main facilitators of SSR were related to the innovation, social setting and economic and political context, such as completeness of diagnostic reports, support in completing structured templates, and the incorporation of the use of SSR in national guidelines. Discussions: Multiple studies have published findings regarding MDT members favoring SSR for its completeness and readability during MDT meetings. In this study, completeness was seen as a facilitator, whereas the readability of the SSR had to be improved. Complementary, this study shows important communication and technical related barriers that have to be dealt with in the implementation process of SSR. In order to determine the most important barriers, the findings of this qualitative study should be quantified, using a nationwide survey. Conclusions: MDT members benefit from the use of SSR by multiple disciplines, as diagnostic reports are more complete. The impeding factors related to all domains. After quantification of the factors, the most important can be used to develop implementation tools to encourage SSR implementation. Lessons learned: The care processes, for example the MDT meetings, differ between types of hospitals. In addition, hospitals use different hospital information systems. Consequently, MDT members experience different impeding factors of SSR. Limitations: The study population was limited to MDT members, operating in the field of urological, gynecological or gastrointestinal oncology. However, we assume that barriers and facilitators experienced by these MDT members correspond with the impeding factors experienced by MDT members, operating in other fields of oncology. Suggestions for future research: The qualitative findings of this study could be quantified, using a nationwide survey. Next, the most important barriers and facilitators of SSR among MDT members can be used to develop implementation tools to encourage SSR implementation among multiple disciplines.

Keywords

• standardized structured reporting
• multidisciplinary team
• implementation
• pathology
• quality improvement