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Swillens JEM, Nagtegaal ID, Engels S, Lugli A, Hermens RPMG, van der Laak JAWM. Pathologists' first opinions on barriers and facilitators of computational pathology adoption in oncological pathology: an international study. Oncogene 2023; 42:2816-2827. [PMID: 37587332 PMCID: PMC10504072 DOI: 10.1038/s41388-023-02797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Computational pathology (CPath) algorithms detect, segment or classify cancer in whole slide images, approaching or even exceeding the accuracy of pathologists. Challenges have to be overcome before these algorithms can be used in practice. We therefore aim to explore international perspectives on the future role of CPath in oncological pathology by focusing on opinions and first experiences regarding barriers and facilitators. We conducted an international explorative eSurvey and semi-structured interviews with pathologists utilizing an implementation framework to classify potential influencing factors. The eSurvey results showed remarkable variation in opinions regarding attitude, understandability and validation of CPath. Interview results showed that barriers focused on the quality of available evidence, while most facilitators concerned strengths of CPath. A lack of consensus was present for multiple factors, such as the determination of sufficient validation using CPath, the preferred function of CPath within the digital workflow and the timing of CPath introduction in pathology education. The diversity in opinions illustrates variety in influencing factors in CPath adoption. A next step would be to quantitatively determine important factors for adoption and initiate validation studies. Both should include clear case descriptions and be conducted among a more homogenous panel of pathologists based on sub specialization.
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Affiliation(s)
- Julie E M Swillens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Iris D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sam Engels
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
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Swillens JEM, Voorham QJM, Akkermans RP, Nagtegaal ID, Hermens RPMG. Nationwide implementation of a multifaceted tailored strategy to improve uptake of standardized structured reporting in pathology: an effect and process evaluation. Implement Sci 2022; 17:52. [PMID: 35907877 PMCID: PMC9338618 DOI: 10.1186/s13012-022-01224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Implementation strategies are aimed at improving guideline adherence. Both effect and process evaluations are conducted to provide insights into the success or failure of these strategies. In our study, we evaluate the nationwide implementation of standardized structured reporting (SSR) in pathology. Methods An interrupted time series analysis was conducted to evaluate the effect of a previously developed implementation strategy, which consisted of various digitally available elements, on SSR in pathology laboratories. A segmented regression analysis was performed to analyze the change in mean SSR percentages directly after the strategy introduction for pathology reporting and specific subcategories. In addition, we analyzed the change in trend in the weekly percentages after strategy introduction, also for subgroups of tumor groups, retrieval methods, and type of laboratory. The change in SSR use after the strategy introduction was determined for all pathology laboratories. We further conducted a process evaluation in which the exposure to the strategy elements was determined. Experiences of the users with all strategy elements and the remaining barriers and potential strategy elements were evaluated through an eSurvey. We also tested whether exposure to a specific element and a combination of elements resulted in a higher uptake of SSR after strategy introduction. Results There was a significant increase in an average use of SSR after the strategy introduction for reporting of gastrointestinal (p=.018) and urological (p=.003) oncological diagnoses. A significant increase was present for all oncological resections as a group (p=.007). Thirty-three out of 42 pathology laboratories increased SSR use after the strategy introduction. The “Feedback button”, an option within the templates for SSR to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users, and effectiveness results showed that it increased average SSR use after the strategy introduction. Barriers were still present for SSR implementation. Conclusions Nationwide SSR implementation improved for specific tumor groups and retrieval methods. The next step will be to further improve the use of SSR and, simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can facilitate proper treatment decisions in oncology. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01224-5.
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Affiliation(s)
- Julie E M Swillens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands.
| | | | - Reinier P Akkermans
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands
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Swillens JEM, Voorham QJM, Nagtegaal ID, Hermens RPMG. Evidence-Based Selection, Development, and Testing of a Tailored Strategy to Improve Standardized Structured Reporting in Pathology. Arch Pathol Lab Med 2022; 146:1496-1507. [PMID: 35417541 DOI: 10.5858/arpa.2021-0236-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Standardized structured reporting (SSR) among pathologists results in more complete diagnoses and, subsequently, improved treatment decisions and patient outcomes. Therefore, SSR templates' usage is advocated in oncology guidelines. However, actual SSR usage varies widely. Previous studies have shown multiple impeding and facilitating factors regarding SSR implementation. OBJECTIVE.— To select, develop, and test an evidence-based multifaceted strategy, tailored to the impeding and facilitating factors to improve SSR implementation in oncologic pathology. DESIGN.— Six strategy elements to increase the use of SSR were selected on the basis of a barrier and facilitator analysis, literature review, and consecutive discussions with a nationwide expert panel and project team. In collaboration with a professional organization for developing SSR templates (PALGA), we developed elements and combined them in 1 multifaceted strategy and subsequently tested effectiveness and feasibility. RESULTS.— The 6 strategy elements were as follows: (1) renewed Web site including SSR information; (2) e-learning including SSR instructions; (3) communication manual describing communication about SSR; (4) improved feedback process, including use of the "Feedback Button" within SSR templates and "Frequently Asked Questions" on the Web site; (5) information sheet on SSR updates within SSR templates; and (6) monthly telephone conversations to discuss audit and feedback information regarding local SSR usage. A significant change (12.4%) in SSR usage among test laboratories was noticed. After the first test, e-learning and the "Feedback Button" were deemed most feasible and effective. However, awareness of all elements could be increased. CONCLUSIONS.— Next step will be to optimize the tailored strategy, to distribute it to all Dutch pathology laboratories, and to evaluate effectiveness and feasibility in a nationwide setting.
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Affiliation(s)
- Julie E M Swillens
- From the Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences (Swillens, Hermens)
| | - Quirinus J M Voorham
- The Radboud University Medical Center, Nijmegen, the Netherlands; and PALGA Foundation, Houten, the Netherlands (Voorham)
| | - Iris D Nagtegaal
- The Department of Pathology, Radboud Institute for Molecular Life Sciences (Nagtegaal)
| | - Rosella P M G Hermens
- From the Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences (Swillens, Hermens)
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Swillens JEM, Voorham QJM, Nagtegaal ID, Hermens RPMG. Improving Interdisciplinary Communication: Barriers and Facilitators for Implementation of Standardized Structured Reporting in Oncology. J Natl Compr Canc Netw 2021; 19:1-11. [PMID: 34653965 DOI: 10.6004/jnccn.2021.7002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Standardized structured reporting (SSR) improves quality of diagnostic cancer reporting and interdisciplinary communication in multidisciplinary team (MDT) meetings, resulting in more adequate treatment decisions and better health outcomes. However, use of SSR varies widely among pathologists, but might be encouraged by MDT members (MDTMs). Our objectives were to identify barriers and facilitators (influencing factors) for SSR implementation in oncologic pathology from the perspective of MDTMs and their determinants. METHODS In a multimethod design, we identified influencing factors for SSR implementation related to MDT meetings, using 5 domains: (1) innovation factors, (2) individual professional factors, (3) social setting factors, (4) organizational factors, and (5) political and legal factors. Four focus groups with MDTMs in urologic, gynecologic, and gastroenterologic oncology were conducted. We used an eSurvey among MDTMs to quantify the qualitative findings and to analyze determinants affecting these influencing factors. RESULTS Twenty-three MDTMs practicing in 9 oncology-related disciplines participated in the focus groups and yielded 28 barriers and 28 facilitators in all domains. The eSurvey yielded 211 responses. Main barriers related to lack of readability of SSR: difficulties with capturing nuances (66%) and formulation of the conclusion (43%); lack of transparency in the development (50%) and feedback processes of SSR templates (38%); and lack of information exchange about SSR between pathologists and other MDTMs (45%). Main facilitators were encouragement of pathologists' SSR use by MDTMs (90%) and expanding the recommendation of SSR use in national guidelines (80%). Oncology-related medical discipline and MDT type were the most relevant determinants for SSR implementation barriers. CONCLUSIONS Although SSR makes diagnostic reports more complete, this study shows important barriers in implementing SSR in oncologic pathology. The next step is to use these factors for developing and testing implementation tools to improve SSR implementation.
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Affiliation(s)
- Julie E M Swillens
- 1Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen
| | | | - Iris D Nagtegaal
- 3Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- 1Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen
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Swillens JEM, Sluijter CE, Overbeek LIH, Nagtegaal ID, Hermens RPMG. Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed method study. Virchows Arch 2019; 475:551-561. [PMID: 31270615 PMCID: PMC6861434 DOI: 10.1007/s00428-019-02609-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 12/24/2022]
Abstract
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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Affiliation(s)
- J E M Swillens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands.
| | - C E Sluijter
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - L I H Overbeek
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands
| | - I D Nagtegaal
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands
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