Implementation of fracture risk assessment in men with prostate cancer requiring long-term androgen deprivation therapy: a systematic scoping review using the i-PARIHS implementation framework

Huang, Qizhi; Mitchell, Caroline; Theodoulou, Elisavet; Lee, Andrew C. K.; Brown, Janet

Abstract

Purpose
Androgen deprivation therapy (ADT) is a mainstay of treatment for prostate cancer (PCa) and is associated with increased risks of osteoporosis and fragility fractures. Despite international guidelines to mitigate fracture risk, osteoporosis is under-diagnosed and under-treated due to poor implementation. This scoping review aims to synthesise knowledge surrounding the implementation of guidelines to inform health service interventions to reduce fracture risk in men with PCa-taking ADT (PCa-ADT).

Method
Four databases and additional literature were searched for studies published between January 2000 and January 2023. Studies that provided evidence influencing guidelines implementation were included. The i-PARIHS (Promoting Action on Research Implementation in Health Services) implementation framework was used to inform the narrative synthesis.

Results
Of the 1229 studies identified, 9 studies met the inclusion criteria. Overall, an improvement in fracture risk assessment was observed across heterogeneous study designs and outcome measures. Six studies were from Canada. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilised an implementation framework. Implementation barriers included the lack of knowledge for both patients and clinicians, time constraints, unsupportive organisational structures, and challenges in transferring patient care from specialists to primary care. Effective strategies included education, novel care pathways using a multidisciplinary approach, incorporating a healthy bone prescription tool into routine care, point-of-care interventions, and bespoke clinics.

Conclusion
There is an unmet need to provide evidence-based bone healthcare in men with PCa receiving ADT. This study highlights barriers and strategies in the implementation of fracture risk assessment for PCa-ADT patients.

Implications for Cancer Survivors
Primary care clinicians can play a significant role in the management of complications from long-term cancer treatment such as treatment-induced bone loss. Future studies should consult patients, families, specialists, and primary care clinicians in service re-design.

Citation

Huang, Q., Mitchell, C., Theodoulou, E., Lee, A. C. K., & Brown, J. (in press). Implementation of fracture risk assessment in men with prostate cancer requiring long-term androgen deprivation therapy: a systematic scoping review using the i-PARIHS implementation framework. Journal of Cancer Survivorship, https://doi.org/10.1007/s11764-024-01659-3

• Journal Article Type: Review
• Acceptance Date: Aug 2, 2024
• Online Publication Date: Aug 14, 2024
• Deposit Date: Aug 23, 2024
• Journal: Journal of Cancer Survivorship
• Print ISSN: 1932-2259
• Electronic ISSN: 1932-2267
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s11764-024-01659-3
• Keywords: Prostatic cancer; Androgen deprivation therapy; Osteoporosis; Cancer survivorship; Implementation; Primary health care
• Public URL: https://keele-repository.worktribe.com/output/887838
• Publisher URL: https://link.springer.com/article/10.1007/s11764-024-01659-3
• Additional Information: Received: 4 March 2024; Accepted: 2 August 2024; First Online: 14 August 2024; : ; : The authors declare no competing interests.