Clinical practice guidelines are intended to improve the consistency and quality of medical care through improving the incorporation and prompt translation of evidence from research to the bedside.1,2 In recent years, as the evidence base has grown more complex, guidelines have proliferated,1,3,4 including those specifically pertaining to cancer management.5
Scholars have devoted considerable attention to defining the optimal processes for guideline development and have investigated the impact of guidelines, with many concluding that their use is associated with improved processes of care, clinical outcomes, and patient satisfaction.6-10 Research has also considered physicians’ attitudes, which may differ according to specialty and practice setting.11,12
Although studies have shown that physicians generally find clinical practice guidelines helpful, they have also revealed several perceived limitations of guidelines that may affect adherence.5,13-15 In a comprehensive analysis of barriers to physician adherence to guidelines, Cabana et al16 identified 7 general categories of barriers that have been explored in previous studies, including lack of familiarity, lack of awareness, lack of agreement with guidelines, lack of outcome expectancy, lack of self-efficacy (physicians’ perceptions that they cannot perform the recommended behavior), lack of motivation, and external barriers.
Little recent information exists regarding physicians’ use of cancer management guidelines5 or about the barriers to guideline use in cancer care specifically. To address these gaps in the existing literature, the authors conducted a nationwide survey of medical oncologists and surgeons who had seen at least one new patient with breast cancer in the past year. They chose to study these providers because breast cancer management is inherently multidisciplinary and based on a complex evidence base that lends itself particularly well to guideline development. The authors sought to address 3 areas of question: 1) what are physician attitudes toward cancer management guidelines in general; 2) how familiar with existing guidelines are physicians who treat patients with breast cancer, how do they use these guidelines, and how often do they believe their recommendations are guideline-compliant; and 3) do attitudes, familiarity, use, or compliance with guidelines differ by specialty or other physician characteristics?
This work was supported by a Young Investigator Award from the National Comprehensive Cancer Network to Dr. Jagsi. The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
Institute of Medicine. Clinical practice guidelines we can trust. Available at: http://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. Accessed December 20 2014.
EcclesMPGrimshawJMShelkelleP. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci2012;7:60.
GenuisSJ. The proliferation of clinical practice guidelines: professional development or medicine-by-numbers?J Am Board Fam Pract2005;18:419–442.
DillmonMDGoldbergJMRamalingamSS. Clinical practice guidelines for cancer care: utilization and expectations of the practicing oncologist. J Oncol Pract2012;8:350–353.
GrimshawJMRussellIT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet1992;342:1317–1322.
WorrallGChaulkPFreakeD. The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. CMAJ1997;156:1705–1712.
RekerDMDuncanPWHornerRD. Postacute stroke guideline compliance is associated with greater patient satisfaction. Arch Phys Med Rehabil2002;83:764–770.
PieperCHaagSGesenhuesS. Guideline adherence and patient satisfaction in the treatment of inflammatory bowel disorders—an evaluation study. BMC Health Serv Res2009;9:17.
BrandCLandgrenFHutchinsonA. Clinical practice guidelines: barriers to durability after early implementation. Intern Med J2005;35:162–169.
WardMMVaughnTEUden-HolmanT. Physician knowledge, attitudes and practices regarding a widely implemented guideline. J Eval Clin Pract2002;8:155–162.
LugtenbergMBurgersJSBestersCF. Perceived barriers to guideline adherence: a survey among general practitioners. BMS Fam Pract2011;21:98.
CabanaMDRandCSPoweNR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA1999;282:1458–1465.
BennettCLSomerfieldMRPfisterDG. Perspectives on the value of American Society of Clinical Oncology clinical guidelines as reported by oncologists and health maintenance organizations. J Clin Oncol2003;21:937–941.
MartinezSRBealSHChenSL. Disparities in the use of radiation therapy in patients with local-regionally advanced breast cancer. Int J Radiat Oncol Biol Phys2010;78:787–792.
FreedmanRAHeYWinerEPKeatingNL. Trends in racial and age disparities in definitive local therapy of early-stage breast cancer. J Clin Oncol2009;27:713–719.
DuXLGorBJ. Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women, 1992 to 2002. Ethn Dis2007;17:122–128.