Fracture risk assessment in men with prostate cancer requiring androgen deprivation therapy: a systematic scoping review using the i-PARIHS implementation framework

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

7A.1

Presenter:

Rebecca Mawson

Co-authors:

Caroline Mitchell, Elisavet Theodoulou, Andrew Lee, Janet Brown, Qizhi Huang

Author institutions:

The University of Sheffield

Problem

Androgen deprivation therapy (ADT) is a mainstay of treatment of prostate cancer (PCa) and often administered in primary care. ADT is associated with reduced bone mineral density and increased risk of fractures. Despite international guidelines to mitigate fracture risk, osteoporosis is under-diagnosed and under-treated in this population due to poor implementation.

The aim of the study is to synthesize knowledge surrounding the implementation of guidelines and strategies to inform health service interventions to reduce fracture risk in men with PCa taking ADT.

Approach

Four databases and additional literature were searched. Inclusion criteria: studies that reported measures to improve fracture risk assessment for men with PCa-ADT in all healthcare settings were included worldwide. The population was defined as patients with PCa taking long-term ADT. The intervention criteria were studies designed to improve fracture risks assessment. Outcomes included: improvement in BMD measurement or fracture risk assessment, and/or changes in prescription of BPA. The i-PARIHS (Promoting Action on Research Implementation in Health Services) framework was used to inform the narrative synthesis.

Findings

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 a Canadian research group. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilized an implementation framework. Intervention strategies included education, novel care pathways using a multidisciplinary approach and incorporating existing services, point-of-care interventions, and bespoke clinics. Barriers included lack of knowledge for both patients and clinicians, time constraints and unsupportive organisational structures.

Consequences

Guideline implementation requires contextualisation and innovation to address barriers and enablers. Future studies should incorporate patient and clinician perspectives and test interventions in primary care.

Submitted by:

Qizhi Huang

Funding acknowledgement:

We would like to thank the National Institute for Heath and Care Research for funding the clinical lectureship for Dr Qizhi Huang to carry out this study.