IMPACT OF A CLINICAL GUIDELINES PROGRAM FOR BREAST AND COLON-CANCER IN A FRENCH CANCER CENTER

Context.-Between 1993 and 1994, the 80 physicians in the French compre hensive cancer center, Leon Berard, developed and implemented a Clinic al Practice Guidelines (CPGs) project based on an analysis of the lite rature and a consensus of intrainstitutional experts. Objective.-The a ims of this project are to assist community-based oncologists in their decision making and to minimize inappropriate variation in practices. A study was designed to assess the impact of CPGs on management of br east and colon cancer. Design.-A ''before-after'' study, using institu tional computerized records of patients with breast or colon cancer. S etting.-Records for 100 women with localized breast cancer were random ly selected from those available in 1993 and 1995, and those for all p atients newly referred with colon cancer in 1993 and 1995 (77 and 81 p atients, respectively). Medical decisions on these records were analyz ed to assess their compliance with the CPGs. (A systematic search of t he literature was performed to determine the scientific evidence for n oncompliant decisions.) Results.-Of 375 available medical decisions, 3 50 were assessable. The compliance rate with CPGs for breast cancer wa s significantly higher in 1995 compared with 1993, 54% (54/99; 95% con fidence interval [CI]; 44%-64%) vs 19% (18/95; 95% CI, 11%-27%) (P<.00 1), The compliance rate for colon cancer was also significantly higher in 1995 than in 1993, 70% (62/88; 95% CI, 60%-80%) vs 50% (34/68; 95% CI, 38%-62%) (P=.009), In 1993, 42% (40/95; 95% CI, 32%-52%) of medic al decisions for breast cancer and in 1995, 68% (67/99; 95% CI, 59%-77 %) conformed with the CPGs or were judged to be based on ''scientific evidence.'' In 1993, 71% (48/68; 95% CI, 60%-81%) of medical decisions for colon cancer, and in 1995 81% (71/88; 95% CI, 73%-89%) conformed with the CPGs or were judged to be based on scientific evidence. Concl usions.-Compliance rates were significantly higher in 1995 for both ca ncers. The development and implementation of CPGs for cancer managemen t seem to result in significant changes in medical practice, although a causal relationship between changes and CPGs is not demonstrated in this study.