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Diffusion and Dissemination of Evidence-based Cancer Control Interventions
Evidence Reports/Technology Assessments, No. 79
Peter Ellis, MBBS, MMed, PhD, FRACP, Paula Robinson, MD, MSc, Donna Ciliska, PhD, Tanya Armour, PhD, Parminder Raina, PhD, Melissa Brouwers, PhD, Mary Ann O'Brien, MSc, Mary Gauld, BA, and Fulvia Baldassarre, MSc.
Structured Abstract
Questions:
What is the effectiveness of cancer control interventions (i.e., smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) to promote behavior uptake? What strategies have been evaluated to disseminate cancer control interventions?
Data sources:
Studies were identified by searching MEDLINE, PREMEDLINE, Cancer LIT, EMBASE/Excerpta Medica, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and reference lists and by contacting technical experts.
Study selection:
For effectiveness studies, English-language systematic reviews (since 1990) were selected if they stated inclusion criteria for primary studies, reported the review methods, and evaluated 1 of the 5 cancer control interventions in individuals or healthcare providers. For dissemination and diffusion, English-language primary studies (since 1980) were selected if they evaluated the dissemination of 1 of the 5 cancer control interventions in individuals, healthcare providers, or institutions. Studies of children or adolescents only were excluded.
Data extraction:
2 reviewers independently extracted data on patients, interventions, and outcomes. Disagreements were resolved by consensus. The quality of study and review methods was also assessed.
Main results:
41 reviews on effectiveness and 31 studies on dissemination and diffusion were included. Studies were not meta-analyzed because of heterogeneity, low methodological quality, and incomplete data reporting. Adult Smoking Cessation: effective smoking cessation interventions included brief advice by a healthcare professional, office prompts, media campaigns, and office reminders combined with physician training with or without patient education. No strong evidence currently exists for effective dissemination studies. Adult Healthy Diet: Effective interventions for promoting a healthy diet included physician education in dietary counselling, tailored interventions, multiple interventions, and provision of multiple contacts and environmental interventions. No beneficial dissemination strategies were found except for the use of peer educators in the worksite, which led to a short-term increase in fruit and vegetable intake. Mammography: Effective interventions included invitations or mailed reminders, office system interventions, and financial barriers interventions. Insufficient evidence exists for the effectiveness of any dissemination strategy. Cervical Cancer Screening: Effective interventions included office systems and invitations and reminders to individuals. Limited evidence supports the effectiveness of educational materials, telephone counseling, removal of financial barriers, media campaigns, and healthcare provider advice. No evidence exists for dissemination strategies. Control of Cancer Pain: Inadequate evidence exists for effective interventions. Dissemination of a treatment algorithm for pain management resulted in a short-term change in provider adherence. Few studies on dissemination exist.
Conclusion:
Some cancer control interventions are effective for changing provider or individual behavior. Little research has been done on dissemination strategies
Contents
- Preface
- Acknowledgment
- Summary
- 1. Introduction
- 2. Methodology
- 3. Review of Reviews on the Effectiveness of Cancer Control Interventions
- 4. Primary Studies that Evaluate Strategies used to disseminate cancer control interventions
- 5. Conclusions
- 6. Future Directions for Research
- Evidence Tables
- Appendixes
- References
- Bibliography
Co-Task Order Leaders: Dr Parminder Raina, Dr Peter Ellis.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract Number: 290-97-0017. Prepared by: McMaster University Evidence-based Practice Center, Hamilton, Ontario, Canada.
Suggested citation:
Ellis P, Robineson P, Ciliska D, et al. Diffusion and Dissemination of Evidence-based Cancer Control Interventions. Evidence Report/Technology Assessment Number 79. (Prepared by McMaster University under Contract No. 290-97-0017.) AHRQ Publication No. 03-E033 Rockville, MD: Agency for Healthcare Research and Quality. May 2003.
On December 6, 1999, under Public Law 106-129, the Agency for Health Care Policy and Research (AHCPR) was reauthorized and renamed the Agency for Healthcare Research and Quality (AHRQ). The law authorizes AHRQ to continue its research on the cost, quality, and outcomes of health care and expands its role to improve patient safety and address medical errors.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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