Srinivasaiah N, Monson J R
Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
Colorectal Dis. 2008 Nov;10(9):873-8. doi: 10.1111/j.1463-1318.2008.01500.x. Epub 2008 Mar 4.
A national questionnaire survey on management of rectal cancer suggested that despite the evidence of the CRO7 trial supporting the use of neoadjuvant short-course radiotherapy for operable rectal cancer, approximately two-thirds of consultant surgeons in the UK still have to implement this treatment regime routinely. However, 39% of surgeons have changed their practice following the early dissemination of trial results. Change in clinical practice is driven by a number of factors.
To determine factors influencing changing clinical practice in the use of radiotherapy in rectal cancer.
A 14-item questionnaire was designed to inquire into the current management strategy of operable rectal cancer and the possible role of neoadjuvant radiotherapy. A postal questionnaire survey was sent to all the active consultant members of the Association of Coloproctology of Great Britain and Ireland. Data for this article have been drawn from the subset of results constituting the comments section in the questionnaire. Qualitative methodology was adopted to analyse the comments section.
Of 400 questionnaires, 200 (50%) were returned completed. Of these, only 52 (26%) surgeons completed the comments section. Themes that emerged from thematic analysis were: Patient groups, Treatment, Evidence-based practice (EBP), Professional consensus and Service provisions. The derived outcomes were: individualization of treatment, safer and less harmful treatment, increased role of multidisciplinary teams, need to increase awareness of the current evidence-based literature, develop protocols and guidelines along with shortening the delay in implementing EBP and good service provisions.
In conclusion, change in practice is a slow and complex process influenced not only by data and scientific evidence, but also by a combination of other factors. Some of them are Clinical decision making, EBP/Education, Research Translation and Organizational factors with Infrastructure/Resources. Some of the above-mentioned conclusions will aid the policy makers and the opinion leaders in the National Health Service (NHS).
一项关于直肠癌管理的全国性问卷调查表明，尽管CRO7试验的证据支持对可手术直肠癌使用新辅助短程放疗，但英国约三分之二的顾问外科医生仍不得不常规实施这种治疗方案。然而，39%的外科医生在试验结果早期传播后改变了他们的做法。临床实践的改变受多种因素驱动。
确定影响直肠癌放疗临床实践改变的因素。
设计了一份包含14个条目的问卷，以探究可手术直肠癌的当前管理策略以及新辅助放疗的可能作用。向英国和爱尔兰结直肠外科学会的所有在职顾问成员发送了邮寄问卷调查。本文的数据取自问卷中构成评论部分的结果子集。采用定性方法分析评论部分。
在400份问卷中，200份（50%）被完整返回。其中，只有52名（26%）外科医生完成了评论部分。主题分析得出的主题有：患者群体、治疗、循证实践（EBP）、专业共识和服务提供。得出的结果是：治疗个体化、更安全且危害更小的治疗、多学科团队作用增强、需要提高对当前循证文献的认识、制定方案和指南，同时缩短实施循证实践的延迟以及提供良好的服务。
总之，实践改变是一个缓慢而复杂的过程，不仅受数据和科学证据影响，还受其他多种因素综合影响。其中一些因素是临床决策、循证实践/教育、研究转化以及具有基础设施/资源的组织因素。上述一些结论将有助于英国国民医疗服务体系（NHS）的政策制定者和意见领袖。
