Is breast cancer care in accord with clinical practice guidelines: a consumer audit

To assess whether information, support and other psychosocial care for women with early breast cancer in Australia is in accord with published Australian clinical practice guidelines.

An interview survey of a population-based sample of women with early breast cancer.

The whole of Australia.

Women diagnosed with early breast cancer 6-12 months before the survey were identified through the population-based cancer registries. An initial sample of 1184 women was drawn from the cancer registries; the doctors of 104 women did not agree to any participation and a further 212 women were excluded as ineligible. A randomly selected sample of 832 of the 868 women who were eligible to participate were invited to participate in the study and 544 (76%) of the 716 who could be contacted completed a full interview.

A telephone interview covering 12 aspects of care recommended in the published guidelines.

Most women received care in accord with the following recommendations: diagnosis given by a senior doctor (95%), face to face (86%) and in an open manner (90%). Fewer women received recommended care in relation to: involvement in decision making (73%), information about clinical trials (13%); receiving breast reconstruction following mastectomy (8%), evidence-based consumer guides (62%) and adequate support for families (65%).

The extent to which the provision of information, support and psychosocial care is in accord with recommendations can be audited effectively by a survey of women who have received treatment. Some 80% or more of women received care in accord with half of the 12 target guidelines; however, further programmes are required to improve access to information and participation in clinical trials and to better understand participation in decision making.