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Implementing guidelines about colorectal cancer: a national survey of target groups
M Gattellari1, J Ward, M Solomon
1Central Sydney Area Health Service, Needs Assessment and Health Outcomes Unit, New South Wales, Australia.
Background:
An Australia-wide postal survey was undertaken to determine surgeons' attitudes towards guidelines and their preferred strategies for dissemination and implementation of guidelines for the management of colorectal cancer, developed by the Australian Cancer Network (ACN) and the Clinical Oncological Society of Australia (COSA). This survey was conducted as a baseline before the release of the definitive guidelines.
Methods:
All members of the Royal Australasian College of Surgeons (RACS) with a self-nominated special interest in colorectal surgery and members of the Colorectal Surgical Society of Australia (CSSA) were surveyed.
Results:
A total of 195 of the 219 surgeons eligible for the study returned questionnaires (89% response rate). Most (86%) were aware that these guidelines were being developed. More than one-half had read at least one draft version. Almost half (44.6%; 95%CI: 37.6-51.9%) agreed that guidelines represented 'cookbook medicine' and one-third (33.3%; 95%CI: 26.9-40.5%) agreed that guidelines might increase the number of malpractice suits. Local adaptation of guidelines and 'academic detailing' were most favourably ranked to assure implementation. Further, 54.9% (95%CI: 47.6-61.9%) of respondents believed that a successful legal defence of a surgeon whose practice had been within the guidelines would encourage uptake. Surgeons operating outside teaching hospitals were more likely to endorse this view than others.
Conclusions:
These results demonstrate that an important target group for colorectal cancer guidelines, namely surgeons, appears receptive to clinical practice guidelines. These results could also permit interventions that target attitudinal barriers to implementing guidelines and subgroups of surgeons who have particular concerns. Expensive strategies for implementation ought to be subject to rigorous evaluation for their impact in modifying clinical practice.
Insights
Australian surgeons are receptive to colorectal cancer guidelines, with local adaptation and academic detailing favored for implementation. Understanding surgeon attitudes is key to guideline adoption and improving patient care.
Area of Science:
- Oncology
- Surgical Practice
- Health Services Research
Background:
- Developed colorectal cancer guidelines by the Australian Cancer Network (ACN) and Clinical Oncological Society of Australia (COSA).
- Undertook an Australia-wide postal survey to gauge surgeons' baseline attitudes towards these guidelines before their release.
Purpose of the Study:
- To determine surgeons' attitudes towards clinical practice guidelines for colorectal cancer management.
- To identify preferred strategies for guideline dissemination and implementation among surgeons.
Main Methods:
- Surveyed members of the Royal Australasian College of Surgeons (RACS) and the Colorectal Surgical Society of Australia (CSSA) with a colorectal surgery interest.
- Achieved an 89% response rate from 195 eligible surgeons.
Main Results:
- Most surgeons (86%) were aware of the developing guidelines, with over half reading a draft.
- Nearly half (44.6%) viewed guidelines as 'cookbook medicine,' and 33.3% feared increased malpractice suits.
- Local adaptation and 'academic detailing' were preferred implementation strategies; 54.9% believed legal defense within guidelines would encourage uptake.
Conclusions:
- Surgeons, a key group for colorectal cancer guidelines, show receptiveness to their adoption.
- Identified attitudinal barriers and surgeon subgroups that may require targeted interventions for guideline implementation.
- Recommended rigorous evaluation of expensive implementation strategies for their impact on clinical practice modification.