[The physicians' view on the utility and impact of oncological guidelines in clinical practice. A survey of Piedmont physicians]

Abstract

Objective: To determine whether the guidelines (LGR) prepared in Piedmont for the treatment of colorectal and breast cancer reached the targetphysician population and how they were been perceived by physicians.

Design: We invited all Piedmont hospital units that had treated at least 5 cases of colon-rectal or breast cancer in 2002 to participate to the survey. Physicians had to fill a short mail questionnaire. The questionnaire had three sections: distribution and implementation, quality of the instrument, utility and applicability.

Results: Replies were 65% (53/82) and 73% (105/143) respectively for the for colon rectal cancer guidelines (LGR-CR) and for breast cancer guidelines (LGR-M)). Among responders, 6% and 9% units ignored the existence of the LGR-CR and LGR-M respectively. More than 50% responders participated in the LGR presentation meetings and/or working groups for the local implementation of LGR. Overall the units judged the LGR quality positively. The LGR utility was judged positively for LGR-CR but opinions were heterogeneous for LGR-M. The LGR-M were judged unable to improve the doctor-patient relationship--or the continuity of care.

Conclusion: The physicians who replied to the questionnaires had received the LGRs and are familiar with them. Furthermore they had a positive attitude towards the instrument. The LGR-CR seems to be better accepted than LGR-M, for which some resistance was found among gynaecologists and radiotherapists. However, very few responders described how they formally implemented the instrument in their clinical practice. Absence of LGR promotion activities (such as working groups) and low patient volume were relevant factors in limiting local implementation.