Carrick S E, Bonevski B, Redman S, Simpson J, Sanson-Fisher R W, Webster F
NHMRC National Breast Cancer Centre, Sydney, NSW.
Med J Aust. 1998 Sep 21;169(6):300-5. doi: 10.5694/j.1326-5377.1998.tb140280.x.
To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer (the Guidelines) and their views about and use of the accompanying Consumer's guide.
Cross-sectional telephone survey.
Surgeons throughout Australia who manage breast cancer, designated as "breast" or "general" (members or non-members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and "urban" or "rural".
Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelines and believed they were useful in improving women's management and wellbeing, easy to understand, evidence-based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that "women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting". In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%; P < 0.001). Only 37% of surgeons routinely gave the Consumer's guide to all or more than half their patients.
Surgeons are generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.
探讨外科医生对澳大利亚国家健康与医学研究委员会（NHMRC）早期乳腺癌管理临床实践指南（以下简称《指南》）的看法，以及他们对随附的《消费者指南》的看法和使用情况。
横断面电话调查。
澳大利亚各地负责乳腺癌治疗的外科医生，分为“乳腺外科”或“普通外科”（澳大利亚皇家外科学院乳腺外科分会成员或非成员）以及“城市”或“农村”地区的外科医生。
在150名受访者中（回复率为64%），超过80%的外科医生表示已阅读了全部或大部分《指南》，并认为其有助于改善女性的治疗和健康状况，易于理解，基于证据，是近期证据的良好总结，且有助于女性与医疗服务提供者达成共识。外科医生认同《指南》中的大部分建议，但26%的医生不同意“理想情况下，女性应由治疗大量类似患者且能在多学科环境中提供全面治疗方案的专科医生进行治疗”这一观点。在医疗法律影响方面，41%的医生认为《指南》会保护临床医生，而在认为《指南》会给医生带来更多问题的37%的外科医生中，乳腺外科医生持此观点的比例显著高于普通外科医生（50%对19%；P<0.001）。只有37%的外科医生会常规地将《消费者指南》提供给所有或半数以上的患者。
外科医生总体上对《指南》持积极态度，但要实现其最佳实施还需解决某些问题，包括对医疗法律影响的困惑、提供多学科护理的认知困难以及《消费者指南》的使用不足。
