Barriers and enablers to the implementation of dementia biomarkers into clinical practice: a scoping review protocol
Le résumé fourni par la source
The landscape of dementia care is undergoing a foundational paradigm shift driven by advancements in fluid (cerebrospinal fluid and blood-based) and neuroimaging (PET, SPECT, MRI) biomarkers. These diagnostic tools enable accurate, biologically specific identification of neuropathology early in the disease trajectory, a transition made urgent by the recent approval of disease-modifying therapies that necessitate biomarker confirmation for treatment eligibility. Despite this diagnostic evolution, operationalising dementia biomarkers within routine clinical practice presents profound implementation challenges across multi-tiered health systems. Health services differ markedly in organisational readiness, specialist infrastructure, clinical workforce capacity, and financial resources. Without structured implementation frameworks, the rollout of biomarker technologies risks amplifying existing health disparities in diagnostic access, particularly across rural and under-resourced settings. The purpose of this scoping review is to systematically map the multi-level contextual barriers, enablers, and implementation strategies associated with integrating dementia biomarkers into secondary and tertiary specialist clinical care (as well as diagnostic pathways spanning primary and specialist care). Guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported in accordance with PRISMA-ScR guidelines, this review synthesises evidence across diverse empirical, review, and policy literature published from 2010 onward. Extracted findings are analysed using a dual qualitative approach: inductive thematic coding into six core clinical domains (Diagnostic-related, Patient-level, Clinician-level, Organisational-level, System-level, Equity-related) and deductive mapping onto the 48 constructs of the updated 2022 Consolidated Framework for Implementation Research (CFIR 2022) across its five domains (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process).
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