Abstract
Introduction: Considerable resources are invested to produce clinical practice guidelines (CPGs) for management of MS, to improve the quality and standard of care. However, uptake among clinicians in Australia remains unclear. We aimed to investigate MS clinicians’ awareness, acceptance and use of CPGs; and related barriers and facilitators.
Methods: Semi-structured interview guides were developed using Fisher’s framework to assess personal, guidelines-related, and external barriers to CPGs use; based on the knowledge-attitude-behaviour model embedded in social psychology. MS clinicians were recruited through professional bodies and MS societies. Three researchers conducted online interviews between June-October 2023. NVivo was used for inductive and deductive analysis using the framework.
Results: We interviewed 10 MS nurses and six neurologists from public and private settings; 12 women and four men, and nine had >10 years neurology-specialty experience. Despite most clinicians believing that CPGs can improve consistency, safety and quality of care; the use of CPGs was highly variable. Personal barriers included low awareness and familiarity. Guideline-related barriers included accessibility, layout and complexity. External barriers included organisational constraints and lack of resources. Facilitators to using CGPs included relevance to local protocols, covering complex treatment or unfamiliar topics; and when CPGs were up-to-date and developed by a trusted source. Most clinicians reported the need to apply CPGs in conjunction with clinical reasoning and considering the individual’s circumstances and preferences, in the context of a heterogenous disease such as MS. Team collaboration, and professional education, were potential strategies to better apply CPGs as well as alternatives to CPGs use. Clinicians reported a lack of CPGs on pregnancy and breastfeeding.
Conclusion: This study found low awareness of, and variability in the use of CPGs. With considerable resources invested in the development of CPGs, these should in future be better aligned with local needs, easily accessible and regularly updated.