Use of knowledge translation frameworks to implement diagnosis of upper quadrant lymphedema clinical practice guideline to improve patient care.

PURPOSE: This knowledge translation (KT) descriptive study aimed to improve adherence to upper quadrant lymphedema clinical practice guideline (CPG) volume measurement recommendations.

METHODS

Physical therapists and leaders from 3-outpatient clinics who receive referrals for surveillance and treatment of cancer-related upper quadrant lymphedema were included in this 2-year descriptive study. The Knowledge to Action and Consolidated Framework for Implementation Research were used to improve fidelity and adherence to CPG recommended practices.

RESULTS

Clinicians and leaders scored highly on readiness for change questions at baseline. Chart audits (n = 176) showed improvement in all fidelity metrics: use of consistent increment of circumference measures improved from 0% to 94%, bilateral measures 43% to 94%, follow-up circumference measures 60% to 77%, and use of evidence-based volume difference metrics for appropriate referral 0% to 80%. Adherence decreased over time, ranging between 33% to 90% at the last chart audit. There was variability in the changes to clinician knowledge and beliefs about lymphedema measures documented at the end of the project.

CONCLUSIONS

This study demonstrated a feasible KT process to improve adherence to lymphedema measurement guidelines in outpatient clinics. Inconsistent adherence may impact clinical decision-making and limit patient access to appropriate care to manage this chronic condition.