Barriers to quality cancer care: a qualitative exploration of oncology case managers’ experiences in facilitating guideline implementation in Taiwan

Abstract

Background

In cancer care, the use of clinical practice guidelines (CPGs) has been shown to improve the quality and effectiveness of medical services. To facilitate physicians’ adherence to these guidelines, Taiwan established the position of oncology case manager (OCM) in 2010, one of whose responsibilities is to monitor physicians’ compliance. However, there have been few explorations of their experiences and the barriers they face in facilitating guideline implementation.

Objective

The aim of this study was to explore how OCMs carry out their roles in facilitating the implementation of CPGs in Taiwan and the challenges they encounter in this process.

Methods

In this study, a qualitative interpretative phenomenological analysis (IPA) approach focusing on interpreting phenomena was adopted. The subjects were eight OCMs from the same hospital in Taiwan. Data collection primarily involved conducting interviews, supplemented by document analysis.

Results

The analysis revealed the following challenges for OCMs in the process of facilitating guideline implementation: (1) Local production: Self-directed exploration leads to significant pressure. (2) Operational modes: Difficulties arise in the “low-ranking overseeing high-ranking” approach. (3) Accountability mechanisms: OCMs are saddled with the chore of managing evaluation.

Conclusion/practical implications

Guidelines are vital tools to ensure the quality of cancer care. However, based on the experiences of OCMs, shortcomings in institutional design, hierarchical organizational culture, misconceptions about the role of OCMs, and a lack of support from management have been identified as key obstacles in the implementation process. Suggestions of ways to address these challenges and promote successful guideline implementation are proposed.