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Changing Clinical Practice: Evaluation of Implementing Recommendations for Opportunistic Salpingectomy in British Columbia and Ontario
  1. Bryn Lander, PhD*,,
  2. Elizabeth Wilcox, MA,
  3. Jessica N. McAlpine, MD*,
  4. Sarah J. Finlayson, MD*,
  5. David G. Huntsman, MD§,
  6. Dianne Miller, MD* and
  7. Gillian E. Hanley, PhD*
  1. *Division of Gynecologic Oncology, University of British Columbia, Vancouver General Hospital;
  2. Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver Coastal Health Research Institute; and
  3. School of Population and Public Health, and
  4. §Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  1. Address correspondence and reprint requests to Gillian Hanley, PhD, 6th Flr Gynecology, 2775 Laurel St, Vancouver, British Columbia, Canada, V5Z 1M9. E-mail: gillian.hanley@vch.ca.

Abstract

Objective The aim of the study was to explore the factors that contributed to the adoption of opportunistic salpingectomies (removal of fallopian at the time of hysterectomy or in lieu of tubal ligation) by gynecologic surgeons in British Columbia (where a knowledge translation initiative took place) and in Ontario (a comparator where no knowledge translation initiative took place). We aimed to understand why the knowledge translation initiative undertaken by OVCARE in British Columbia resulted in such a dramatic uptake in opportunistic salpingectomy.

Methods We undertook a qualitative evaluation of clinicians' decisions about whether or not they should adopt the practice of opportunistic salpingectomy based on interviews with gynecologic surgeons in British Columbia and Ontario (n = 28). The analysis draws from the Consolidated Framework for Implementation Research.

Results Regional cohesion combined with practice change information exposure and thought leader support were important in explaining differences in adoption levels between participants. The British Columbian knowledge translation campaign was successful because provincial thought leaders exposed gynecologic surgeons to recommendations through multiple sources within a highly socially cohesive environment wherein clinicians felt pressure to adopt the recommendations. In both provinces, high adopters often believed that the workload and surgical risk associated with the adoption was low and the potential benefit—because of limited ovarian cancer detection and treatment options—was high.

Conclusion This research points to the important role that local professional networks can play in encouraging clinicians to change their practice by creating a cohesive regional environment where clinicians are repeatedly exposed to important information and supported in their practice change by local thought leaders.

  • Opportunistic salpingectomy
  • Consolidated framework for implementation research
  • Knowledge translation
  • Practice change
  • Ovarian cancer prevention

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Footnotes

  • The research was supported by (donor) funds from the Vancouver General Hospital and University of British Columbia Hospital Foundation. The donors wish to remain anonymous for these funds. G.H. is supported by the Canadian Cancer Society Research Institute and has a Canadian Institutes for Health Research New Investigator award. B.L. was supported by the Michael Smith Foundation for Health Research Postdoctoral Fellow award.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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