SURGEONS OPINIONS ABOUT THE NHMRC CLINICAL-PRACTICE GUIDELINES FOR THE MANAGEMENT OF EARLY BREAST-CANCER

Objective: To explore the opinions of surgeons about the NHMRC clinica l practice guidelines for the management of early breast cancer(the Gu idelines) and their views about and use of the accompanying Consumer's guide. Design: Cross-sectional telephone survey. Participants and set ting: Surgeons throughout Australia who manage breast cancer, designat ed as ''breast'' or ''general'' (members or non-members of the Royal A ustralasian College of Surgeons' Section of Breast Surgery) and ''urba n'' or ''rural''. Results: Among 150 respondents (64% response rate) m ore than 80% of surgeons reported having read all or most of the Guide lines and believed they were useful in improving women's management an d wellbeing, easy to understand, evidence-based, a good summary of rec ent evidence, and that they would assist agreement between women and h ealthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that ''women should ideally be tr eated by a specialist who treats a large number of similar patients an d who has access to the full range of treatment options in a multidisc iplinary setting''. In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of su rgeons who believed that they would expose doctors to increased proble ms, 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. Conclusions: Surgeons a re generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confus ion about the medicolegal implications, perceived difficulties with pr oviding multidisciplinary care and poor use of the Consumer's guide.