Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use

Abstract

Purpose: To determine (1) Canadian oncologists’ attitudes toward practice guidelines, (2) oncologists’ self-reported use of practice guidelines and, (3) physicians’ characteristics and attitudes associated with self-reported use of practice guidelines. Participants and Methods: A cross-sectional, self-administered postal survey was administered to Canadian oncologists. Main outcome measures were level of agreement with 8 descriptive statements about guidelines, score on the attitudinal scale of the guideline of Tunis et al., and physicians’ stated use of guideline. χ² and logistic regression procedures were used to explore the relationship between physician characteristics and use of guidelines. Results: Over 80% of respondents agreed that they were good educational tools, convenient sources of advice, intended to improve quality of care; over 40% agreed that they were unbiased syntheses of expert opinion. Conversely, 42, 26, 20 and 16% felt they were intended to cut costs, were oversimplified cookbook medicine, were too rigid to apply to individual patients, and a challenge to physicians’ authority, respectively. Forty-one percent reported using practice guidelines routinely or most of the time. Use was associated with positive attitudes about guidelines, receiving medical school training abroad and being a radiation oncologist. Conclusion: Canadian oncologists were quite positive about practice guidelines and reported using them frequently. Our results suggest that use of guidelines by oncologists may be related to attitudes about guidelines in general, specialty within oncology and country of medical school training.

Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

“…Previous international studies [5,8,9,18,37] that used the Tunis attitudinal scale have also indicated the impact of guidelines as tools to improve the quality of health care, as good educational tools and convenient sources of advice. Nevertheless, physicians criticized the guidelines as being oversimplified, too rigid, and a threat to physician autonomy (Table 4).…”

“…In Germany, a representative survey of 194 primary-care physicians [17] revealed that 161 (77.9%) were aware of at least one set of guidelines, and 76 (41.1%) used guidelines. A survey of Canadian oncologists [18] revealed that 41% applied guidelines. The reported use has been shown to be correlated with positive attitudes toward guidelines in general.…”

“…It is associated with advanced age, and the prevalence and incidence rates are expected to increase in the future. The long-term nature of the disease leads to a considerable economic burden for individual patients and society as a whole [18,21,22]. Therefore, selection of the most appropriate of the wide range of available diagnostic and therapeutic options should be based on reliable standards for patient care and should reflect the current scientific knowledge.…”

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“…For example, they note past challenges in making physicians aware of CPGs and in addressing practitioners' perceptions of their relevance and utility. 1 Therefore, while the Task Force knows it is essential to develop the guideline using a systematic and evidence-based approach, they also see the need to consider ways to increase the acceptability and uptake of the CPG. The Task Force hires a consultant on behavior change.…”

From practice guidelines to clinical decision support: closing the loop

“…22 Absence of patient-specific guidance: CPGs cannot deal with the specifics of each case because their authors cannot foresee the details of every possible clinical situation in which they may be applied. 23 The conventional text CPG suffers from: …”