Abstract / Summary
Abstract Background Structured reporting templates are described as improving report quality, consistency and clinical communication, yet adoption in routine practice remains limited. In Sweden, an evidence-based national template for rectal cancer staging has been available since the mid-2010s, but it remains unclear which determinants shape its adoption and how adoption translates into perceived outcomes. This study assessed the implementation status of these templates, with primary focus on rectal cancer, and characterised the associated determinants, outcomes and strategies. Methods A national cross-sectional web-based survey of clinically active radiologists and radiology department heads was conducted between August and November 2025. The updated Consolidated Framework for Implementation Research was used to identify barriers and facilitators, Proctor's taxonomy to evaluate service and implementation outcomes, and the Expert Recommendations for Implementing Change to link barriers to evidence-based strategies. Analyses were descriptive, with proportions reported as Wilson 95% confidence intervals. Professional role was the primary moderator, and findings were organised as retrospective determinant-to-strategy pathways, linking observed determinants and outcomes to proposed strategies. Results Of 50 respondents, 34 reported active use and 33 were analysed for determinants and outcomes. Implementation was most commonly champion-driven (48% of rollouts), and local champions were rated as strong facilitators more often than formal management (36% vs 21%). No respondent rated incentives as a strong facilitator or implementation cost as a major barrier (both 0%, 95% CI 0–10%). Templates were perceived to improve clinical effectiveness while creating workflow friction for a minority (Service Effectiveness 91% improved; Service Efficiency 44% improved, 19% worsened). Among active users, adoption ratings exceeded continued-engagement and sustainment ratings (79% vs 39%). Conclusions Structured reporting templates were perceived to deliver clear clinical value but to create workflow friction that fell unevenly across professional roles, and high adoption was not matched by continued engagement and sustainment. Uptake rested on local champions rather than economic levers, so strategies that pair champion engagement with workflow adaptation and formal organisational ownership may be needed. Because the sample was small and self-selected and the design was cross-sectional, causal relationships and strategy effects were not tested.