Epithelial ovarian cancer surgical staging by Ontario gynaecologic surgeons: is there a gap between current practice and the Canadian clinical practice guidelines?

OBJECTIVES

By determining, through self-report, Ontario gynaecologic surgeons' practices regarding surgical staging for epithelial ovarian cancer, this study aimed to quantify the gap between current practice and the ideal practice of surgical staging for ovarian cancer, as defined by the corresponding Canadian clinical practice guidelines.

METHODS

All 711 active Ontario gynaecologic surgeons identified from the website of the College of Physicians and Surgeons of Ontario were confidentially surveyed by mail, using a structured questionnaire to explore individuals' surgical management of an adnexal mass suspicious for epithelial ovarian cancer, using a clinical case simulation. Specifically, gynaecologic surgeons' adherence to the CPGs was determined by self-report, and various physician characteristics were explored for potential associations with adherence to the CPGs in the clinical case simulation using the Fisher exact test.

RESULTS

The survey response rate was 69.8%. Only 44.3% of Ontario gynaecologic surgeons adhered to the CPGs in their responses to the clinical case simulation. Gynaecologic oncologists were more likely than non-oncologists to self-report surgical staging according to the CPGs during the clinical case simulation (P = 0.0004). Adherence was also significantly associated with practice at a university centre (P = 0.013) and practice at a centre with a gynaecologic oncologist (P = 0.001) but was not associated with surgical volume.

CONCLUSION

This study has confirmed that a significant gap exists between current practice and the ideal practice of surgical staging for epithelial ovarian cancer in Ontario, as defined by the corresponding Canadian CPGs. Further investigation will explore potential barriers to optimal practice to facilitate the development of a knowledge translation strategy to improve surgical staging for ovarian cancer in Ontario.