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Clinical Practice Guidelines (CPG) distil an evidence base into recommendations. CPG adherence is associated with improved patient outcomes. However, preparing and disseminating CPG is a costly task involving multiple skilled personnel. Furthermore, dissemination alone does not ensure CPG adherence. The reasons for non-adherence are often complex but understanding practice
variation and reasons for non-adherence is key to improving CPG adherence, harmonising clinicallyappropriate and cost-effective care.
Objective To overview approaches to improving guideline adherence, provide urology specific examples of knowledge-practice gaps, and highlight potential solutions informed by implementation science.
Evidence Acquisition Three common approaches to implementation science (the Knowledge-To Action framework, the Consolidated Framework for Implementation Research, and the Behaviour Change Wheel), are summarised.
Evidence Synthesis Three implementation problems in urology are illustrated (underuse of single instillation of intravesical chemotherapy in non-muscle invasive bladder cancer, overuse of androgen deprivation therapy in localised prostate cancer, and guideline discordant imaging in prostate cancer).
Research using implementation science approaches to address these implementation problems is discussed.
Conclusion: Urologists, patients, healthcare providers, funders, and other key stakeholders must commit to reliably capturing and reporting data on patient outcomes, practice variations, guideline adherence, and the impact of adherence on outcomes. Leveraging implementation science frameworks is a sound next step towards improving guideline adherence and the associated benefits of evidence-based care.
Patient Summary: Clinical practice guidelines documents are created by expert panels. These documents provide overviews of the evidence for the tests and treatments used in patient care. They also provide recommendations and it is expected that in most circumstances clinicians will follow these recommendations. Sometimes, healthcare professionals can’t or don’t follow these recommendations and it is not always clear why. In this review article we look at some examples of research approaches to addressing this problem of ‘non-adherence’, and we provide some urology specific examples.
Original languageEnglish
Pages (from-to)1545-1552
Number of pages8
JournalEuropean Urology Focus
Issue number5
Early online date24 Oct 2021
Publication statusPublished - 1 Sept 2022

Bibliographical note

Dr. Skolarus is supported by the National Cancer Institute R01 CA242559 and R37 CA222885. No
conflicts of interest.


  • Clinical practice guidelines
  • Implementation science
  • Evidence-practice gap
  • Behaviour Change Wheel
  • Theoretical Domains Framework
  • Knowledge to Action framework
  • Consolidated Framework for Implementation Research


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