Wright Frances C, Gagliardi Anna R, Law Calvin H L, Last Linda D, Klevan A Eric, Hongjinda Sermsak, Stitt Larry W, Klar Neil, Ryan David P, Smith Andrew J
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room T2-063, Toronto, ON M4N3M5, Canada.
Arch Surg. 2008 Nov;143(11):1050-5; discussion 1055. doi: 10.1001/archsurg.143.11.1050.
Physicians seem to learn best from their peers, yet the impact of opinion leaders on physician behavior is unclear. Because colon cancer staging has been identified as being suboptimal in Ontario, Canada, we sought to evaluate the influence of expert and local opinion leaders for colon cancer on optimizing colon cancer lymph node assessment.
DESIGN, SETTING, PARTICIPANTS: A cluster-randomized trial including all hospitals in Ontario that identified a local opinion leader with intervention between January 5 and June 17, 2004.
All 42 centers received a standardized lecture about colon cancer lymph node assessment delivered by an expert opinion leader in colon cancer. The 21 intervention hospitals also received academic detailing of a local opinion leader by the expert opinion leader and a toolkit.
Mean number of lymph nodes assessed in patients with stage II colon cancer and the proportion of cases staged with a minimum of 12 lymph nodes before and after a standardized lecture were assessed.
Patient demographic and tumor factors were similar in both groups before and after the standardized lecture. Lymph node assessment significantly improved after the standardized lecture at intervention and control sites (P < .001). No additional benefit of academic detailing and toolkit provision in the intervention was demonstrated.
In-person provision of information by an expert opinion leader in colon cancer may stimulate performance regarding lymph node assessment for colon cancer. Academic detailing of a local opinion leader did not further improve lymph node assessment.
医生似乎从同行那里学习效果最佳，但意见领袖对医生行为的影响尚不清楚。由于在加拿大安大略省已确定结肠癌分期存在欠佳情况，我们试图评估结肠癌专家和当地意见领袖对优化结肠癌淋巴结评估的影响。
设计、地点、参与者：一项整群随机试验，纳入安大略省所有医院，这些医院在2004年1月5日至6月17日期间确定了一名当地意见领袖并进行干预。
所有42个中心都接受了由结肠癌专家意见领袖进行的关于结肠癌淋巴结评估的标准化讲座。21家干预医院还接受了专家意见领袖对当地意见领袖的学术指导以及一套工具包。
评估II期结肠癌患者评估的淋巴结平均数量以及在标准化讲座前后至少评估12个淋巴结的病例比例。
在标准化讲座前后，两组患者的人口统计学和肿瘤因素相似。在干预组和对照组，标准化讲座后淋巴结评估有显著改善（P < .001）。未显示干预组中提供学术指导和工具包有额外益处。
由结肠癌专家意见领袖亲自提供信息可能会促进结肠癌淋巴结评估工作。对当地意见领袖的学术指导并未进一步改善淋巴结评估。
