Background: Practice guidelines (PGs) are meant to link professional practice more closely to scientific evidence and improve the quality of patient care. Achieving the potential of PGs involves not only developing high-quality products, but also ensuring the recommendations are used at the point of care.

Objectives: Focusing on PGs for the management of adult cancers, we sought to: describe the intrinsic elements known to influence PG use; identify the ways in which PGs are implemented; and, explore how PG characteristics and contextual factors influence implementation and use.

Methods: We conducted a sequential mixed-methods study. First, we performed a content analysis of all PGs developed for the management of adult cancers in Nova Scotia, Canada, from 2005-2015. Data were extracted related to 22 elements known to influence CPG use. This informed subsequent semi-structured interviews with PG developers and end users to identify ways in which the PGs were implemented, and to gain perspectives about the influence of both PG elements and contextual factors on implementation and use. Two researchers analysed the interview data using the Framework Method.

Results: PGs (n=20) revealed large variation with respect to elements shown to influence PG use. For example, 85% included content related to individualis,ation and objectives. Yet, no PGs (0%) had journal or patient versions; discussed the education, training, or competencies needed to deliver recommendations; contained an explicit statement on anticipated work changes, or on potential direct or productivity costs; or identified barriers or facilitators that might influence PG adoption. Interview data from developers (n=4) and users (n=6) revealed five themes related to PG implementation and use: (1) lack of consistency in PG development; (2) timing and nature of stakeholder engagement; (3) credibility of the PG development process; (4) limited understanding of implementation as an active process; and (5) factors at organisational and system levels influence PG implementation and use.

Conclusions: This study provides complementary data to inform PG implementation and optimise their use in practice.