Austin Bowel Cancer Consortium: changing culture in bowel cancer care

The Austin Bowel Cancer Consortium aimed to identify drivers of clinical decision-making so as to inform a continuous practice improvement approach to the use of evidence. Strategies for engaging clinicians included a direct clinician-clinician approach, gaining the support of opinion leaders and using the clinicians' desire for patient outcome data. Interviews with clinicians identified barriers to using evidence in practice. These included poor integration of medical and surgical disciplines, different learning styles, negative attitudes to guidelines and pathways, and no consensus as to what is an effective multidisciplinary team. A clinical implementation group provided a forum for interaction between disciplines. The group agreed on management pathways covering the continuum of care and developed decision-support software for use in the clinic. Interviews with patients and carers highlighted psychosocial and communication difficulties and prompted greater clinician awareness. Consumers developed patient information resources with minimal assistance from project staff. The clinical encounter is the prime site for change for putting evidence into practice, rather than trying to change individual clinicians.