Approvers, Disapprovers, and Strugglers: a Q-methodology study of rectal cancer MRI proforma use

Rectal cancer MRI (rcMRI) allows accurate staging and informs treatment decisions in rectal cancer. There is variability in reporting completeness; however, template proforma reports can significantly increase the inclusion of key tumour descriptors. We aimed to identify socially shared viewpoints of radiologists relating to barriers to implementing proforma reporting. Measuring the subjectivity of opinions relative to other radiologists will allow identification of common patterns preventing implementation.

Specialist gastrointestinal radiologists from 16 hospital trusts were invited to a Q-methodology study. Participants ranked 56 statements on barriers to using proforma reports (the Q-set) in a normal distribution (Q-grid). Factor analyses were undertaken to identify independent accounts, and additional survey data were used to support interpretation.

Twenty-seven radiologists participated; 11 (41%) had more than 10 years reporting rcMRIs. Three distinct accounts of radiologist attitudes to proforma-use were identified: Approvers, Disapprovers, and Struggling champions. The highest ranked barriers related to proforma format, individual radiologists' preferences and beliefs about efficacy and factors relating to wider multidisciplinary teams and health system-level implementation.

Radiologists that disapprove of proformas are unlikely to use them unless external influences are applied, such as a requirement by treating clinicians. Increased internal and organizational support would also increase use. Targeted implementation strategies focusing on these barriers has the potential to increase uptake of similar interventions.

Specialist radiologists require a multi-level adaptive implementation strategy, tailored to proforma characteristics as well as individual and organizational barriers to increase proforma reporting for rcMRI to support accurate treatment decision making.