The transfer of new knowledge into practice remains a major issue in the delivery of healthcare today. While this review identifies a number of effective cancer control interventions to change provider or individual behavior, it also identifies a need for research into strategies to disseminate these interventions into practice.

Many of the primary studies identified by this report, which evaluated strategies used to disseminate cancer control interventions, demonstrated methodological limitations. The quality of these studies was generally weak and the study designs provided low levels of evidence to answer the questions that were posed. Therefore there are methodological issues that should be considered in future research:

• It is important that future dissemination research focuses on attempts to disseminate effective, evidence-based cancer control interventions
• Many of the studies identified in this review were primarily descriptive rather than evaluative. This raises questions about the most appropriate study designs for dissemination research. Issues for consideration include: what is the role of controlled trial designs in dissemination research? How can non-RCT types of studies make a stronger contribution to the field? What information can be provided from qualitative research (i.e., case studies)? Local barriers may be important factors that reduce the effectiveness of the interventions or the success of dissemination strategies
• What outcomes are important to consider in dissemination research? A number of outcomes can be considered in evaluating dissemination strategies. Much of the research has concentrated on process measures such as numbers of physicians educated, and numbers of individuals contacted. Behavioral outcomes including the delivery of interventions by healthcare professionals, or the uptake of behavioral change by individuals, should be evaluated in future research.
• Are cancer control interventions equally effective when they are more widely disseminated in the community?
• There is inconsistent use of terminology in the literature. Standardized criteria for reporting research findings have been developed in other areas including the CONSORT statement¹⁶² for reporting RCTs and the MOOSE proposal¹⁶³ for observational studies in epidemiology. Would establishing criteria for reporting dissemination research help to clarify this field of research?

This report examined the strategies to disseminate cancer control interventions in the areas of adult smoking cessation, adult healthy diet, screening for breast and cervical cancer, plus control of cancer pain. However, other topics within the cancer control continuum were not addressed in this evidence report. As dissemination approaches may vary across topic areas, there is a need for further systematic reviews to synthesize available data in these areas too. Future systematic reviews should consider the following:

• What strategies have been used to disseminate cancer control interventions to promote other preventive behaviors such as increased physical activity or avoidance of exposure to ultraviolet radiation; screening activities including screening for colorectal cancer; and the therapeutic areas of cancer treatment and supportive care?
• What approaches have been undertaken to improve compliance/maintenance? Do the approaches to promote long-term behavioral change differ from those required to promote the uptake of behavioral change?
• What strategies are effective to improve recall following an abnormal screening examination? What strategies promote long-term adoption of screening behaviors?

Some suggestions for future research were common across several of the five topic areas examined in this evidence report. Those issues, along with several more general considerations that should be considered in future research examining diffusion and dissemination of cancer control interventions, include:

• How can theoretical models of behavior change inform future dissemination research?
• What approaches can be undertaken to make dissemination and dissemination research a routine component of intervention research?
• Do dissemination strategies along the cancer continuum differ from dissemination approaches in other areas of healthcare?
• What approaches can be undertaken to incorporate dissemination strategies into healthcare policy?
• What policy level interventions are effective at promoting dissemination of evidence-based cancer control interventions?
• What is the cost-effectiveness of different cancer control interventions and strategies to disseminate them? This may be an important local issue in determining approaches to dissemination.
• What is the role of new technologies in dissemination research? What is the potential of the Internet as a dissemination tool?
• Can audit and feedback, local opinion leaders, and educational outreach be used to effectively disseminate cancer control interventions? These approaches are effective interventions to change provider behavior in other situations, but have not been well evaluated in the topic areas examined in this evidence report.
• What characteristics of healthcare providers and individuals contribute to increased or decreased success of dissemination approaches?
• What is the most appropriate approach to combine provider and patient directed cancer control interventions?
• What is the importance of local barriers to effective dissemination of cancer control interventions?

Some additional issues were identified for future research that is specific to the individual topic areas in this evidence report. These are summarized below.