Improving discussion of surgical treatment options for patients with breast cancer: local medical opinion leaders versus audit and performance feedback

We studied whether a hospital intervention utilizing medical opinion leader s and performance feedback reduced the proportion of women who reported tha t surgeons did not discuss options prior to surgery for early stage breast cancer. Opinion leaders provided clinical education to their peers using a variety of strategies and were selected for their ability to influence thei r peers. Performance feedback involved distributing performance reports tha t contained data on the outcomes of interest as well as on other treatment patterns. Twenty-eight hospitals in Minnesota were randomized to the interv ention or to a control group that received performance feedback only. The p roportion of patients at intervention hospitals who said that their surgeon did not discuss options decreased significantly (p < 0.001) from 33% to 17 %, but a similar decrease was observed among control hospitals. Using medic al opinion leaders to intervene in hospitals appeared as effective as perfo rmance feedback.