Specific Implementation Strategies
The following strategies have been identified as being essential to achieve the successful implementation of the guidelines. The strategies identified are practical and realistic for the New Zealand setting and are listed in order to promote a systematic and logical approach to the steps required.
Endorsement
Endorsement of the guidelines by medical professional organisations is recognized as being an important part of their validation and acceptance by clinicians.
Quick Reference Clinical Format
Although the full guideline is needed to demonstrate that all aspects of this subject were adequately researched and referenced, information relevant to decision-making needs to be quickly and easily available to the clinician in the clinical setting. The development and availability of a quick reference summary will make the use of the guideline recommendations easier for clinicians.
Publication of the Full Guideline
The full guideline and quick reference guide will be available in electronic form on the New Zealand Guidelines Group (NZGG) Web site at www.nzgg.org.nz. There is no charge for downloading these documents. Print copies will also be available.
Consumer Information
A brochure based on this guideline will be developed for people at increased risk of colorectal cancer and their families.
Dissemination
Dissemination of the guideline needs to ensure that all interested parties are identified and copies of the guideline are circulated to them.
The summary of the guideline recommendations and details of the Web site for access to the full guideline will be distributed to the following categories of practitioners and organisations:
Health Professionals
- General practitioners
- General physicians and surgeons
- Gastroenterologists
- Colorectal surgeons
- Clinical geneticists
- Oncologists
- Pathologists
- Genetic counselors
Provider Organisations, Institutions, and Professional Bodies
- Primary Health Organisations
- Independent Practitioner Associations
- District Health Boards
- Academic lecturers/curriculum planners involved in medical training
- Medical colleges/professional bodies
Agencies and Community Organisations
- The Cancer Society of New Zealand Inc. (CSNZ)
- Health insurers (e.g., Southern Cross)
- Support groups for individuals with colorectal cancer (CRC)
- Consumer interest groups
- Community health agencies and interest groups
Events, Presentation, and Training
Education and formal presentations regarding the content, recommendations, and rationale, as well as the use and applicability of the guideline, are a critical part of the implementation strategy.
They will need to occur at a number of levels and will be ideally facilitated nationally and locally by members of the subcommittee.
The following approaches should be used:
National Level
- Formal endorsement and presentations at appropriate general practitioner/specialty and subspecialty conferences
- Organizing information and education seminars/workshops (based on the guideline) for practitioners, Primary Health Organisations, Independent Practitioner Associations, and District Health Boards
- Specific educational initiatives for particular groups (e.g., general practitioners)
- Efforts made to ensure all sessions include the discussion of how information for consumers about screening/surveillance for CRC is appropriately dealt with to avoid overstating the risk and to minimize consumer demand for inappropriate screening
- Training provided for any areas of practice where shortcomings related to the guideline recommendations are identified
- A resource for consumers should be developed to reflect the recommendations in this guideline
Local Level
- Planned regional education sessions for relevant medical specialties
- Providing sessions for the discussion of prioritizing colonoscopic services for each region with the aim of updating local referral guidelines to reflect the evidence-based guideline recommendations
- Interactive regional and hospital continuing medical education (CME) sessions
- Educational Independent Practitioner Association outreach activities
Publicity
This approach will need to be handled with care because currently, after review of the evidence, population-based CRC screening is not advised in New Zealand for individuals at average risk of developing CRC. Informing the public will require considerable clarity to highlight the factors associated with a moderate increase in risk for developing CRC without encouraging those at average risk to seek out CRC screening tests.
Journals and Other Publications for Health Professionals
- Medical journal articles
- Nursing journal articles
- GP Weekly
- Doctor newspaper
- CSNZ Cancer Update in Practice Bulletin
Launch of Guideline Combined with an Introductory Seminar
- Informing the public
- Consumer information leaflet: develop appropriate consumer information leaflet in association with the Cancer Society of New Zealand (CSNZ)
- Use of lay media to publish articles on CRC that clarify who is at moderate to high risk of developing CRC and who should/should not be referred for surveillance
- Radio interviews: the purpose of this guideline is to clarify who is at high risk of developing CRC so that surveillance activities will be strictly limited to this select group. Radio interviews will need to be carefully considered to ensure they convey the right message and do not serve to generate increased interest and expectations with regard to screening for CRC among those not at high risk
Access to Colonoscopy Services
It will be necessary to negotiate specific funding for the staff, clinic time, and equipment needed to enable the provision of colonoscopy services for asymptomatic individuals identified as having a significant increase in risk of developing CRC, within an appropriate timeframe. It is essential that this be organized in a manner that will not adversely impact on those requiring colonoscopic investigation for symptoms. This matter will need to be discussed at both the national (Ministry of Health) and regional (District Health Board) levels.