From a dysphagia clinical trial to a multidisciplinary head and neck clinical pathway – the road to implementation
Reviewed by Roganie Govender

This paper describes the barriers and facilitators to establishing a structured and coordinated multidisciplinary care pathway for patients with head and neck cancer at a medical centre in the USA. The initiative was set in motion by the roll out of a randomised clinical trial of prophylactic swallowing therapy at the centre. At the end of the clinical trial, the MDT agreed to support the adoption of the research protocol more broadly as part of routine practice. The clinical pathway was expanded to include all MDT professionals involved in a patient’s care from initial diagnosis through to five years post-treatment. The authors of this paper discuss a method for evaluation of health service interventions within practice - The Consolidated Framework for Implementation Research (CFIR). They used this method to understand factors that contributed to or hindered both the establishment of the new clinical pathway and its ongoing maintenance. They also examined the outcomes of the speech and language therapy and dietetic components of the pathway and compared these with the initial research cohort conducted under a ‘strict’ research protocol. The main factor identified as contributing to the successful establishment of the pathway was the ‘intervention source’. In other words, the positive experience of the team having experienced the intervention within the prior research trial made it easier to adopt into routine practice. Furthermore, there was good ‘buy-in’ to the evidence for the benefit of early intervention and making patients aware of their expected pathway of care from the outset. The main barriers were the complexity of the pathway and the ongoing routine collection of outcomes at multiple time-points until 24 months after completion of treatment. This paper provides a methodology through which research may be implemented in practice, and a framework for how the process may be evaluated.

Establishing a Multidisciplinary Head and Neck Clinical Pathway: An Implementation Evaluation and Audit of Dysphagia-Related Services and Outcomes.
Messing BP, Ward EC, Lazarus C, et al.
DYSPHAGIA
2019;34:89-104.