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.
Eccles MP, Grimshaw JM, Shelkelle P et al.. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci 2012;7:60.
Genuis SJ. The proliferation of clinical practice guidelines: professional development or medicine-by-numbers? J Am Board Fam Pract 2005;18:419–442.
Dillmon MD, Goldberg JM, Ramalingam SS et al.. Clinical practice guidelines for cancer care: utilization and expectations of the practicing oncologist. J Oncol Pract 2012;8:350–353.
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1992;342:1317–1322.
Worrall G, Chaulk P, Freake D. The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. CMAJ 1997;156:1705–1712.
Reker DM, Duncan PW, Horner RD et al.. Postacute stroke guideline compliance is associated with greater patient satisfaction. Arch Phys Med Rehabil 2002;83:764–770.
Pieper C, Haag S, Gesenhues S et al.. Guideline adherence and patient satisfaction in the treatment of inflammatory bowel disorders—an evaluation study. BMC Health Serv Res 2009;9:17.
Brand C, Landgren F, Hutchinson A et al.. Clinical practice guidelines: barriers to durability after early implementation. Intern Med J 2005;35:162–169.
Carlsen B, Bringedal B. Attitudes to clinical guidelines—do GPs differ from other medical doctors? BMJ Qual Saf 2011;20:158–162.
Ward MM, Vaughn TE, Uden-Holman T et al.. Physician knowledge, attitudes and practices regarding a widely implemented guideline. J Eval Clin Pract 2002;8:155–162.
Lugtenberg M, Burgers JS, Besters CF et al.. Perceived barriers to guideline adherence: a survey among general practitioners. BMS Fam Pract 2011;21:98.
Cabana MD, Rand CS, Powe NR et al.. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458–1465.
Dillman DA, Smyth JD, Christian LM. Internet, mail, and mixed-mode surveys: the tailored design method, 3rd ed. Hoboken, NJ: Wiley & Sons; 2009.
Gradisher WJ, Anderson BO, Blair SL et al.. NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. Version 1, 2014. Available at: NCCN.org. Accessed December 29, 2014.
Bennett CL, Somerfield MR, Pfister DG et al.. Perspectives on the value of American Society of Clinical Oncology clinical guidelines as reported by oncologists and health maintenance organizations. J Clin Oncol 2003;21:937–941.
Martinez SR, Beal SH, Chen SL et al.. Disparities in the use of radiation therapy in patients with local-regionally advanced breast cancer. Int J Radiat Oncol Biol Phys 2010;78:787–792.
Freedman RA, He Y, Winer EP, Keating NL. Trends in racial and age disparities in definitive local therapy of early-stage breast cancer. J Clin Oncol 2009;27:713–719.
Du XL, Gor BJ. Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women, 1992 to 2002. Ethn Dis 2007;17:122–128.