The online version of this article (doi:10.1186/s12904-017-0187-y) contains supplementary material, which is available to authorized users.
Little is known about palliative care professionals’ attitudes towards guidelines. In 2015, the German Association for Palliative Medicine (DGP) published an evidence based guideline for palliative care in adults with incurable cancer. Before publication we conducted a national survey among members of the DGP to detect possible barriers and facilitators for its implementation. The aim of the present publication was to evaluate critical attitudes and beliefs which could hinder the effective implementation of the new guideline and to evaluate differences within professional groups and medical specialisations.
This web-based online survey was addressed to all members of the DGP in summer 2014. Twenty-one questions concerning attitudes and beliefs towards guidelines were a priori developed to represent the following topics: scepticism regarding the quality of guidelines, doubts about the implementation of guidelines, restrictions in treatment options through guidelines, discrepancy between palliative care values and guidelines. Differences within professions and specialisations were tested using Kruskal-Wallis tests.
All 4.786 members with known email address were invited, 1.181 followed the link, 1.138 began to answer the questionnaire and 1.031 completed the questionnaire. More than half of participating members were physicians and one third nurses. Scepticism regarding the quality of existing guidelines was high (range 12.8–73.2%). Doubts regarding practical aspects of guidelines were less prevalent but still high (range 21.8–57.6%). About one third (range 5.4–31.4%) think that guidelines restrict their treatment options. In addition, 38.8% believed that guidelines are a kind of cookbook and restrict the flexibility of individual patient care. The majority saw no or little discrepancy between palliative care values and guidelines (range 68.4–82.6%). There were relatively small but significant differences between professions and specialisations.
The person-centred and individual approach of palliative care does not seem to contradict the acceptance of guidelines. Main barriers were related to scepticism regarding the quality of guidelines and the implementation of guidelines in general.
Additional file 1: Data set supporting the results. (XLSX 100 kb)12904_2017_187_MOESM1_ESM.xlsx
World Health Organization. Definition of palliative care. 2002.
S3- Leitlinie Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung. http://leitlinienprogramm-onkologie.de/Palliativmedizin.80.0.html. Accessed 2 Mar 2017.
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ (Clinical research ed). 1999;318(7182):527–30. CrossRef
Haines A, Donald A. Making better use of research findings. BMJ (Clinical research ed). 1998;317(7150):72–5. CrossRef
Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev (Online). 2010;3:CD005470.
Kunz AU. Leitlinien in der Medizin: Anwendung, Einstellungen und Barrieren - Eine Befragung Berliner Hausärzte. Masters Thesis, Freie Universität Berlin; 2005. http://www.ewi-psy.fuberlin.de/einrichtungen/arbeitsbereiche/ppg/media/projekte/hausaerzte/kunz_2005.pdf. Accessed 2 Mar 2017.
Research TAAfPO. Standard definitions: final dispositions of case codes and outcome rates for surveys. 2015.
Farquhar CM, Kofa EW, Slutsky JR. Clinicians’ attitudes to clinical practice guidelines: a systematic review. Med J Aust. 2002;177(9):502–6. PubMed
Hayward RS, Guyatt GH, Moore KA, McKibbon KA, Carter AO. Canadian physicians’ attitudes about and preferences regarding clinical practice guidelines. Can Med Assoc J. 1997;156(12):1715–23.
Gupta L, Ward JE, Hayward RS. Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact. Med J Aust. 1997;166(2):69–72. PubMed
Field MJ, Lohr KN. In: Guidelines IoMCtAtPHSoCP, editor. Clinical practice guidelines: directions for a new program. Washington: National Academies Press; 1990. Copyright (c) National Academy of Sciences (US).
German Association of the Scientific Medical Societies (AWMF) -Standing Guidelines Commission. AWMF Guidance Manual and Rules for Guideline Development, 1st Edition 2012. English version. Available at: http://www.awmf.org/leitlinien/awmf-regelwerk.html. Accessed 2 Mar 2017.
Albizu-Rivera A, Portman DG, Thirlwell S, Codada SN, Donovan KA. Implementation of NCCN Palliative Care Guidelines by member institutions. Support Care Cancer. 2016;21(1):110–8. doi: 10.1634/theoncologist.2015-0234.
- Critical attitudes and beliefs towards guidelines amongst palliative care professionals – results from a national survey
Steffen T. Simon
- BioMed Central
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