Canadian Partnership Against Cancer, 145 King Street West, Toronto, ON M5H 1J8, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON K1H, 8L6, Canada.
Curr Oncol. 2021 Jan 19;28(1):565-573. doi: 10.3390/curroncol28010056.
: Diagnosis and surgical treatment decision making for breast cancers has become increasingly complex. Recently, Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of breast cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants of their implementation nationally. : This study was undertaken in two parts-(1) National survey of breast cancer surgeons to assess the perceived extent of implementation of these standards in their institution and province; (2) Formation of a focus group with a representative sample of breast surgeons across Canada to further understand the barriers and facilitators towards future breast standards implementation. : 35 surgeons participated in the survey: 66% were from community hospitals. There were four categories of standards that were the most significantly lacking across the country-(a) processes related to quality assurance, (b) turnaround time for pathology results (c) psychosocial and health-related support for the breast cancer patient and (d) breast reconstruction for patients undergoing mastectomy. The focus group included participants from all ten Canadian provinces. For each standard, the 134 determinants fell into three main categories-individual physician (n = 27, 20%); organizational (n = 46, 34%), and system (n = 61, 46%). While specific determinants were present for each category, surgical standards were more likely to be implemented in practice if (1) they aligned with organizational priorities standards; (2) the individual physicians or physician groups were accountable to the organization and/or cancer jurisdiction regarding compliance with the standard; and (3) if infrastructure or resources existed within the organization or system for the reliable collection of relevant, meaningful, practice changing data combined with the capability of benchmarking, peer-peer comparisons and timely feedback to the surgeons. : The results of this study demonstrated variation, barriers and opportunities for the national implementation of CPAC's breast cancer surgery standards and identified determinants of high-quality breast surgical care delivery.
乳腺癌的诊断和手术治疗决策变得越来越复杂。最近，加拿大癌症伙伴关系（CPAC）发布了针对乳腺癌患者护理的泛加证据基础手术标准。本研究旨在评估这些标准在实践中的实施程度，并进一步了解其在全国范围内实施的决定因素。
（1）对乳腺癌外科医生进行全国调查，以评估他们所在机构和省份对这些标准的实施程度的看法；（2）成立一个由加拿大各地乳腺外科医生代表组成的焦点小组，进一步了解未来乳腺标准实施的障碍和促进因素。
35 名外科医生参与了调查：66%来自社区医院。全国范围内有四个类别的标准明显缺乏：（a）与质量保证相关的流程；（b）病理结果的周转时间；（c）乳腺癌患者的心理社会和健康相关支持；（d）接受乳房切除术的患者的乳房重建。焦点小组包括来自加拿大十个省的参与者。对于每个标准，134 个决定因素分为三个主要类别：个体医生（n=27，20%）；组织（n=46，34%）和系统（n=61，46%）。虽然每个类别都存在具体的决定因素，但如果以下条件存在，外科标准更有可能在实践中得到实施：（1）它们与组织优先事项标准一致；（2）个体医生或医生群体对组织和/或癌症管辖机构负责遵守标准；（3）如果组织或系统内存在可靠收集相关、有意义、改变实践的数据的基础设施或资源，以及对外科医生进行基准测试、同行比较和及时反馈的能力。
本研究结果表明，CPAC 乳腺癌手术标准在全国范围内的实施存在差异、障碍和机遇，并确定了提供高质量乳腺外科护理的决定因素。
