THE USE OF CLINICAL PRACTICE GUIDELINES IN ONCOLOGY: THE CHALLENGE OF HARMONIZATION

Abstract

A growing tendency in medicine is the use of clinical practice guidelines to harmonize clinical practice. Researchers have noted the tension between the clinician’s individual autonomy and the constraints imposed by these guidelines. However, research on their use and appropriation by local actors deserves to be developed to better understand what is happening on the ground. The aim of our research was to better understand how they are used and appropriated in oncology. Even though the research focuses on the COVID crisis, it explores factors important to guideline use both during epidemics and in normal practice. The methodology consisted of qualitative, semi-structured interviews with clinicians and management in oncology in two hospitals in Lyon, France during the COVID pandemic. Our results indicate the ethical and epistemological reasons that guidelines were followed (or not) during the pandemic and the active role of clinicians in their formulation and implementation. We will discuss the question of trust in a guideline, how a flexible use of guidelines may safeguard institutional agility, and for what reasons a deviation may be justified in an ethics of care. The research contributes to better understandings of the dynamic role that local actors play in guideline development, appropriation, and use. It shows that while guidelines remain a standard from which their practices are to be compared (and justified), clinicians use them in a flexible manner and are active in evaluating and deciding how they will be implemented in their structures.