Oncology Practice Guidelines: Do They Work?

Author: Rodger J. Winn MD
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One of the major premises supporting the development of clinical practice guidelines is that they promote increased consistency in health care practices.1 A decrease in random variation in this care, we reason, will, in turn, lead to better patient outcomes, increased patient confidence and satisfaction, and more efficient use of resources.2 Is this premise correct? In a review of 59 non-cancer guidelines, Grimshaw and Russell3 reported that 55 led to a change in medical practice, and 9 of 11 showed an improvement in patient outcomes. In a review of oncology-related guideline studies, Smith and Hillner4 noted some evidence of the effect of guidelines and critical care pathways on decreasing costs, but pointed out the need for more data about other outcomes. In attempting to answer the question of whether oncology guidelines “work,” we can assess a multiplicity of end-points: • Have oncologists accepted the basic premise that guidelines are useful? • Are oncologists aware that guidelines exist, and do they access them? • Do the practice patterns of oncologists conform to standard guidelines recommendations? • Does the implementation of guidelines change oncology practice behavior? • Does the use of guidelines lead to better patient outcomes? Oncologist Acceptance of the Concept In line with other specialties,5 modern oncologists seem to acknowledge the utility of clinical practice guidelines. In a survey of Canadian oncologists,6 86% agreed with a statement that guidelines were a useful educational tool, and 83% believed they were a good source of advice, whereas only 4% of those surveyed...

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Rodger J. Winn is the Editor-in-Chief of JNCCN, as well as chair of the NCCN's Guidelines Steering and Principal Investigators Committees. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

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