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03.07.2019 | Original Article Open Access

Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed method study

Virchows Archiv
J. E. M. Swillens, C. E. Sluijter, L. I. H. Overbeek, I. D. Nagtegaal, R. P. M. G. Hermens
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00428-019-02609-6) contains supplementary material, which is available to authorized users.
Ms. Swillens and Ms. Sluijter were lead contributors for this article
The manuscript was presented at the following meetings
- Werkgroep Epidemiologisch onderzoek Nederland (WEON) 2017: Epidemiological methods for implementation research. Antwerp, 8 June 2017
- 29th European Congress of Pathology: Pathology for patient care. Amsterdam, 5 September 2017
This article is part of the Topical Collection on Quality in Pathology

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Standardized structured reporting (SSR) enables high-quality pathology reporting, but implementing SSR is slow. The objective of this study is to identify both barriers and facilitators that pathologists encounter in SSR, in order to develop tailored implementation tools to increase SSR usage. We used a mixed method design: a focus group interview helped to identify barriers and facilitators in SSR. The findings were classified into the following domains: innovation, individual professional, social setting, organization, and economic and political context. We used a web-based survey among Dutch pathologists to quantify the findings. Ten pathologists participated in the focus group interview, and 97 pathologists completed the survey. The results of both showed that pathologists perceive barriers related to SSR itself. Particularly its incompatibility caused lack of nuance (73%, n = 97) in the standardized structured pathology report. Regarding the individual professional, knowledge about available SSR-templates was lacking (28%, n = 97), and only 44% (n = 94) of the respondents agreed that using SSR facilitates the most accurate diagnosis. Related to social setting, support from the multidisciplinary team members was lacking (45%, n = 94). At organization level, SSR leads to extra work (52%, n = 94) because of its incompatibility with other information systems (38%, n = 93). Main facilitators of SSR were incorporation of speech recognition (54%, n = 94) and improvement in communication during multidisciplinary team meetings (69%, n = 94). Both barriers and facilitators existed in various domains. These factors can be used to develop implementation tools to encourage SSR usage.

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Additional file 1 General information about the PALGA foundation (PDF 7 kb)
Additional file 2 Screenshots of the Dutch PALGA SSR-template of breast cancer biopsy (translated from Dutch to English) (PDF 448 kb)
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