Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: protocol paper for a mixed methods study.

Publication date: Feb 27, 2020

Sentinel lymph node biopsy (SLNB) is a diagnostic procedure developed in the 1990s. It is currently used to stage patients with primary cutaneous melanoma, provide prognostic information and guide management. The Australian Clinical Practice Guidelines state that SLNB should be considered for patients with cutaneous melanoma >1?mm in thickness (or >0.8?mm with high-risk pathology features). Until recently, sentinel lymph node (SLN) status was used to identify patients who might benefit from a completion lymph node dissection, a procedure that is no longer routinely recommended. SLN status is now also being used to identify patients who might benefit from systemic adjuvant therapies such as anti-programmed cell death 1 (PD1) checkpoint inhibitor immunotherapy or BRAF-directed molecular targeted therapy, treatments that have significantly improved relapse-free survival for patients with resected stage III melanoma and improved overall survival of patients with unresectable stage III and stage IV melanoma. Australian and international data indicate that approximately half of eligible patients receive an SLNB.

This mixed-methods study seeks to understand the structural, contextual and cultural factors affecting implementation of the SLNB guidelines. Data collection will include: (1) cross-sectional questionnaires and semistructured interviews with general practitioners and dermatologists; (2) semistructured interviews with other healthcare professionals involved in the diagnosis and early definitive care of melanoma patients and key stakeholders including researchers, representatives of professional colleges, training organisations and consumer melanoma groups; and (3) documentary analysis of documents from government, health services and non-government organisations. Descriptive analyses and multivariable regression models will be used to examine factors related to SLNB practices and attitudes. Qualitative data will be analysed using thematic analysis.

Ethics approval has been granted by the University of Sydney. Results will be disseminated through publications and presentations to clinicians, patients, policymakers and researchers and will inform the development of strategies for implementing SLNB guidelines in Australia.

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Rapport, F., Smith, A.L., Cust, A.E., Mann, G.J., Watts, C.G., Gyorki, D.E., Henderson, M., Hong, A.M., Kelly, J.W., Long, G.V., Mar, V.J., Morton, R.L., Saw, R.P., Scolyer, R.A., Spillane, A.J., Thompson, J.F., and Braithwaite, J. Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: protocol paper for a mixed methods study. 25953. 2020 BMJ Open (10):2.

Concepts Keywords
8mm Prognostic guide management
Adjuvant Care melanoma
Australia Organisations consumer melanoma
Australian International III melanoma
BRAF Tumours melanoma
Clinical Practice Guidelines Adjuvant therapies
Cross Immunotherapy
Healthcare Adjuvant therapy
Immunotherapy Medicine
Lymph Node Dissection Clinical medicine
Melanoma Medical specialties
Pathology Cancer
Protocol RTT
Regression Melanoma
Relapse Surgical oncology
Sentinel Lymph Node Sentinel lymph node
SLN Lymph node biopsy
Sydney Lymphadenectomy
Targeted Therapy Adjuvant therapy


Type Source Name
disease MESH chronic diseases
drug DRUGBANK Pembrolizumab
drug DRUGBANK Ipilimumab
drug DRUGBANK Nivolumab
drug DRUGBANK Trametinib
drug DRUGBANK Dabrafenib
disease MESH cancer
drug DRUGBANK Rasagiline
disease MESH privacy
drug DRUGBANK Ademetionine
drug DRUGBANK Trestolone
disease MESH skin cancer
drug DRUGBANK Bismuth subgallate
disease MESH metastases
drug DRUGBANK Coenzyme M
disease MESH noma
disease MESH death
disease MESH development
disease MESH diagnosis
disease MESH relapse
pathway REACTOME Programmed Cell Death
pathway KEGG Melanoma
disease MESH melanoma
disease MESH biopsy


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