By B. Rabin & R. E. Glasgow, 2015, American Psychologist

Supplemental Materials

An Implementation Science Perspective on Psychological Science and Cancer: What Is Known and Opportunities for Research, Policy, and Practice

by B. Rabin & R. E. Glasgow, 2015, American Psychologist

Table S1

Characteristics of Included Reviews

Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Brouwers, M. C., Garcia, K., Makarski, J., Daraz, L. (2001). The landscape of knowledge translation interventions in cancer control: What do we know and where to next? A review of systematic reviews. Implementation Science;6,Article 130. / A review of systematic reviews designed to better understand the evidentiary foundation regarding what is known about KT interventions, to better understand the strengths and limitations of the field, to identify what interventions are ready for use now, and to identify research priorities and directions for the future. / Review of systematic reviews / 2000–2005 / OVERALL REVIEW:
English language systematic reviews
Included cancer as part of the clinical context or that were generic/nonspecific to clinicalcondition
Included at least one outcome of interest:
--measurable clinical outcomes
--observable behavior change
--documented intention to behave
--documented attitudes
--documented knowledge uptake
--reported stakeholder satisfaction
INCLUDED REVIEWS:
Mix of study designs; only four reviews used exclusively non-randomized controlled trial data for primary evidence source. / Diverse:
Community
Home
Healthcare
Other / As outlined in the CADTH-EPOC framework:
Consumers
(patient/public)
Professional (clinician/healthcare provider)
Organization (organizational/managers/system leaders)
Regulatory
Financial / Yes / Diagnoses
Treatment
Follow-up
Survivorship
End-of-life care
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Francke, A. L.,Smit, M. C., de Veer, A. J. E., &Mistiaen, P. (2008). Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review. BMC Medical Informatics and Decision Making, 8,Article 38. / A meta-review designed to gain a better understanding of which factors affect the implementation of guidelines, and to provide insight into the "state-of-the-art" regarding research within this field. / Review of systematic reviews and meta-analyses (systematic meta-review) / No limitation for search period (anything until November 2006) / No limitations for language or search period
Included only systematic reviews or meta-reviews:
--factors that influence guideline implementation either positively or negatively
Excluded:
--studies focused on consensus procedures or consensus-based guidelines were not included
--findings are not only based on research publications, but also on descriptive, narrative or theoretical articles / Not specified / Medical staff
Nurses
Other professionals in health care / No / Not specified
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Boaz, A., Baeza, J., Fraser, A., & the European Implementation Score Collaborative Group (EIS). (2011). Effective implementation of research into practice: An overview of systematic reviews of the health literature. BMC Research Notes, 4,Article212. / A review of systematic reviews of the effectiveness of interventions/implementation methods designed to increase the use of research in clinical practice. / Review of systematic reviews / 1998–2009 / Numerous individual study types (RCT, CCT, BA, ITS)
Included:
--focused on the implementation of research evidence into practice
--clinical guidelines
--audit and feedback
--continuing professional education
--financial incentives
--use of opinion leaders
--multifaceted interventions
--comparisons of different interventions
--compared one type of intervention against a control group
Excluded:
--systematic reviews that did not look explicitly at interventions designed to get research evidence into practice
--systematic reviews that explored changes in provider behavior, but did not state that the changes were research based were excluded
--made no mention of research evidence as were papers that were unclear about the use of research evidence
--focused on evidence-based interventions, but failed to report on the evidence base / Healthcare setting / Healthcare providers
Patients / No / Not specified
Bero, L., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D., Thomson, M. A. (1998). Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. BMJ, 317,Article 465. / Examines systematic reviews of different strategies for the dissemination and implementation of research findings to identify evidence of the effectiveness of different strategies and to assess the quality of the systematic reviews. / Review of systematic reviews / 1966–1995 / Any review of interventions to improve professional performance that reported explicit selection criteria and in which the main outcomes considered were changes in performance or outcome / Health care / Health professionals / No / Not specified
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Brouwers, M. C., De Vito, C., Bahirathan, L., Carol, A., Carroll, J. C., Cotterchio, M., Dobbins, M., Lent, B., Levitt, C., Lewis, N., McGregor, S. E., Paszat, L., Rand, C., Wathen, N. (2011). What implementation interventions increase cancer screening rates? A systematic review. Implementation Science, 6,Article111.
Brouwers, M. C., De Vito, C., Bahirathan, L., Carol, A., Carroll, J. C., Cotterchio, M., Dobbins, M., Lent, B., Levitt, C., Lewis, N., McGregor, S. E., Paszat,, L., Rand, C.,Wathen, N. (2011). Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: An implementation guideline. Implementation Science, 6, Article 112. / A review that assessed what interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and CRC. / Systematic review and review of systematic reviews / 2004–2010 / Randomized controlled trials and cluster randomized controlled trials / Not specified / Not specified / Yes / Screening
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Ellis, P., Robinson, P., Ciliska, D., Armour, T., Brouwers, M., O’Brien, M. A., Sussman, J., & Raina, P.(2005). A systematic review of studies evaluating diffusion and disseminationof selected cancer control interventions. Health Psychology, 5, 488–500.
Ciliska, D., Robinson, P., Armour, T., Ellis, P., Brouwers, M., Gauld, M., Baldassarre, F., Raina, P. (2005). Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer. Nutrition Journal, 4, Article13.
Ciliska, D., Robinson, P., Horsley, T., Ellis, P., Brouwers, M., Gauld, M., Baldassarre, F., Raina, P. (2006). Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer. Current Oncology, 13(4), 130–140. / This review focuses on dissemination research in the area of cancer control. The primary objective was to determine what strategies have been evaluated (including the outcomes assessed) to disseminate cancer control interventions that promote the uptake of behavior change. Five topic areas along the cancer care continuum (smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) were selected to be representative. An overview of studies evaluating the effectiveness of cancer control interventions in the five selected cancer areas was also undertaken, to determine whether appropriate interventions were being selected for dissemination research in this field. / Systematic review / 1980–2005 / All primary studies, regardless of design, were considered eligible for inclusion.
Published in English
Included:
Evaluated dissemination of a cancer control intervention in one of the five topic areas:
--smoking cessation
--healthy diet
--mammography
--cervical cancer screening
--control of cancer pain / Any / Adults
--consumers
--patients
--general public
Healthcare providers / Yes / Prevention Screening Treatment Survivorship
End-of-life
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Rabin, B. A. , Glasgow, R. E., Kerner, J. F., Klump, M. P., Brownson, R. C.. (2010). Dissemination and implementation research on community-based cancer prevention: A systematic review. American Journal of Preventive Medicine, 38(4),:443-456. / The aims of this review were to (1) identify dissemination and implementation studies on the primary prevention of cancer (i.e., smoking, healthy diet, physical activity, sun protection) in community settings; (2) assess their quality; (3) summarize their dissemination- and implementation-related characteristics with a special focus on strategies for dissemination and implementation and measurement issues; and (4) assess their effectiveness. / Systematic review / 1980–2008 / Published in English
Included:
Primary studies that evaluate the dissemination or implementation of effective interventions, were conducted in community (not healthcare) settings.
Excluded:
Policy and media campaign–type interventions were excluded. / Community-based / Adults
Adolescents / Yes / Prevention
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Grimshaw, J., Eccles, M., Thomas, R., MacLennan, G., Ramsay, C., Fraser, C., Vale, L. (2006). Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. Journal of General Internal Medicine21(Suppl. 2),:S14–S20.
Davies, P., Walker, A. E., Grimshaw, J. M. (2010). A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implementation Science, 5, Article 14. / To determine effectiveness and costs of different guideline dissemination and implementation strategies.
A systematic review of the use of theory linked to a large systematic review of the effects of guideline dissemination and implementation strategies (Grimshaw et al.). Assessment of to what extent theory was used in the design of guideline dissemination and implementation interventions, and interpretation of their controlled evaluations. / Systematic review / 1966–1998 / Randomizedcontrolled trials, controlled clinical trials, controlled before and after studies, and interrupted time series evaluating guideline dissemination and implementation strategies targeting medically qualified health care professionals that reported objective measures of provider behavior and/or patient outcome. / Health care / Health care professionals / No / Not specified
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Medves, J., Godfrey, C., Turner, C., Paterson, M., Harrison, M., MacKenzie, L., Durando, P. (2010). Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. International Journal of Evidence-Based Healthcare,8(2),79–89. / To synthesize the literature relevant to guideline dissemination and implementation strategies for healthcare teams and team-based practice. / Systematic review / 1994–2007 / Randomized controlled trials (RCTs), quasi-randomized controlled trials, before and after studies, prospective studies, time series and observational studies were included.
Included:
--studies investigating the economic efficiency of dissemination and/or implementation of interventions
--if healthcare teams collaborated in activities to promote guideline implementation
--studies with explicit identification of team-based practices (i.e., practices including two or more professions/disciplines)
--had to include objective measures of change in provider behavior or patient outcome. / Health care / Health care professionals / No / Not specified
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly,82(4), 581–629. / This article summarizes an extensive literature review addressing the question: How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). The article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewinghealth service policy and management. / Meta-narrative review (systematic review) / Not specified / Included:
--studies from the health care sector that had addressed innovation in service delivery and organization
--looked specifically at the diffusion, dissemination, implementation, and/or routinization of these innovations
--met the authors' criteria for methodological quality
--literature including overview articles and “landmark” empirical studies from outside the health sectorif they had important methodological or theoretical lessons for our research question
Excluded:
Sustainability literature was not included due to its sparsity. / Health care / Health care professionals / No / Not specified
Source / Scope of the review / Type / Years for studies included / Inclusion criteria / Target setting / Target audience / Cancer specific / Stage of cancer control continuum
Hack, T. F., Carlson, L., Butler, L., Degner, L. F., Jakulj, F., Pickles, T., Ruether, J. D., Weir, L. (2011). Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care. Support Care Center,19, 1097–1105. / This review focuses on efforts for the implementation of psychosocial oncology and supportive care interventions. / Narrative review / 1989–2009 / Empirical studies, review papers, theoretical models with relevance to general knowledge transfers or knowledge transfer in psychosocial oncology.
Both qualitative and quantitative studies published in English.
Excluded:
Advice, opinion, editorial pieces / Not specified / Not specified / No / Not specified

Table S2

Findings From Included Reviews

Source / # of individual studies/
papers / Overall quality of included studies / Geographical area for included studies / Study design for included studies / Relevant outcomes / Theory/
Framework / Strategies / Key findings
Brouwers, M. C., Garcia, K., Makarski, J., Daraz, L. (2001) / 19 unique interventions/
34 systematic reviews / Moderate (using AMSTAR rating) / Not specified / RCT only (n =11)
Non-RCT only (n =4)
Mixed (n =26) / Clinical (n =.26)
Behavior observed (n =26)
Behavior intention (n = 9)
Knowledge (n =18)
Attitudes (n =8)
Satisfaction (n =18) / Systematic reviews specifying whether KT theory, model, framework guided design of project or intervention:
--Yes (n =9)
--No (n =8)
--Not specified (n =21) / Consumer interventions:
--Patient education/patient information (n = 8)
--Decision aids/shared decision making (n = 5)
--Interactive health communication applications (n = 1)
--Contracts (n = 1)
--Reminder packaging (n = 1)
--Multifaceted (n = 1)
Professional interventions:
--Educational outreach visits and audit and feedback (n = 4)
--IT/IM/informatic interventions (n = 5)
--Local opinion leaders (n = 1)
--Tailored interventions (n = 1)
--Clinical pathway interventions (n = 1)
--Guidelines for professions allied to medicine (n = 1)
--Discharge planning from hospital to home (n = 1)
Organizational interventions:
--Changing length of consultation (n = 1)
--Routine standardized assessment (n = 1)
--Chronic care model interventions (n = 1)
--Models-of-care/integrated care-related interventions (n = 5)
--Shared-care tactic interventions (n = 1)
--Health information technology (n = 1) / Consumer interventions:
Evidence of effectiveness was most promising for patient education (e.g., improvements in patient knowledge and clinical outcomes); decision aids (e.g., improvements in patient knowledge and satisfaction, reduction in patient decisional conflict, and impact on decisions); and interactive health communication applications (e.g., improvements in knowledge, social support, behavior, and clinical outcomes).
Only one, interactive health communication applications, was rated as being effective. The remaining interventions were rated as promising and candidates for more study.
Professional interventions:
Evidence of effectiveness was most promising for educational outreach and audit and feedback interventions (median improvement in clinical outcomes 5%); clinical decision support (improved clinical performance); computer order entry (reduction in medical errors); clinical pathways (reduction in complication rates); local opinion leaders (reduction in clinician noncompliance); and tailored interventions (improvement in some clinical outcomes). However, these benefits are contrasted against the concerns with the overall quality and lack of consistency across the systematic reviews. Moreover, the primary studies included in the systematic reviews are reported to be of poor quality, heterogeneous, and poorly reported with respect to the interventions, contexts, and measurements of outcomes. Together, this makes definitive conclusions about professional interventions very challenging.
Organizational interventions:
Overall, the reviews were not able to provide definite conclusions (e.g., statistically significant findings) to support the use of any of the specific interventions reviewed. Two of the interventions, changing length of consultation time and shared-care tactic interventions, were rated by members of the research team as not effective(ratings of 3 and under). The remaining interventions fell between 4 and 5 on the scale, indicating promise and are candidates for further study.
Francke, A. L., Smit, M. C., de Veer, A. J. E., Mistiaen, P. (2008) / 12 systematic reviews/693 primary studies / Using the Quality Assessment Checklist for Reviews: The overall scores on this checklist range from “extensive flaws” (score 1 or 2), to “major flaws” (score 3 or 4), “minor flaws” (score 5 or 6), and “minimal flaws” (score 7).
--Minimal flaws (n =1)
--Minor flaws (n =1)
--Major flaws (n =7)
--Extensive flaws (n =2) / Not specified / Mix of study designs for all systematic reviews.
No systematic review that only focuses on RCTs.
Most reviews included quantitative studies with comparative designs (RCTs, CCTs, pre-test post-test studies).
There were three reviews that included surveys qualitative studies exclusively or in addition to the quantitative studies. / Guideline implementation and adherence / Not specified / Variety:
--educational materials
--audit and feedback
--reminders
--multi-faceted interventions / Most of the reviews indicate that effective implementation strategies often have multiple components and that the use of one single strategy, such as reminders only or one educational intervention, is less effective than a combination of strategies. However, interpretation is hampered by the fact that the high-quality Grimshaw review published in 2004 and 2006 does not show a correlation between the number of components in implementation strategies and their effectiveness.
Boaz, A., Baeza, J., Fraser, A. (2011) / 13 systematic reviews on 292 unique individual primary studies / Using an established quality checklist from Oxman and Guyatt and adapted by Franke et al. on a scale of 0 (poor quality) to 7(high quality).
Maximum quality
--score of 7 (n =9)
--score of 6 (n =1)
--score of 5 (n =2)
--score of 4 (n =1)
/ Systematic review origins:
Canada (n =5)
Australia (n =2)
United Kingdom (n =2)
France (n =1)
Germany (n =1)
Italy (n =1)
USA (n =1)
Primary studies:
Most of the reviews included studies from multiple countries (4 did not specify country of origin) / In the systematic reviews, randomized controlled trials (RCT) were favored by the authors over non-RCT study designs.