Abstract
We studied whether a hospital intervention utilizing medical opinion leaders and performance feedback reduced the proportion of women who reported that 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 their peers. Performance feedback involved distributing performance reports that contained data on the outcomes of interest as well as on other treatment patterns. Twenty-eight hospitals in Minnesota were randomized to the intervention or to a control group that received performance feedback only. The proportion 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 medical opinion leaders to intervene in hospitals appeared as effective as performance feedback.
Similar content being viewed by others
References
National Institutes of Health: National Institutes of Health Consensus Development Conference Statement. Treatment of early stage breast cancer. Bethesda, MD: NIH, June 18- 21, 1990
Nayfield SG, Bongiovanni GC, Alciati MH, Fischer RA, Bergner L: Statutory requirements for disclosure of breast cancer treatment alternatives. J Natl Cancer Inst 86: 1202–1208, 1994
Lazovich D, White E, Thomas DB, Moe RE: Underutilization of breast-conserving surgery and radiation therapy among women with Stage I and II breast cancer. JAMA 266: 3433–3438, 1991
Nattinger AB, Hoffman RG, Shapiro R, Gottlieb MS, Goodwin JS: The effect of legislative requirements on the use of breast-conserving surgery. N Engl J Med 335: 1035–1040, 1996
Nattinger AB, Gottlieb MS, Hoffman RG, Walker AP, Goodwin JS: Minimal increase in use of breast-conserving surgery from 1986 to 1990. Med Care 34: 479–489, 1996
Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer: Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section. JAMA 265: 2202–2207, 1991
Soumerai SB, McLaughlin TJ, Gurwitz, Guadagnoli E, Hauptman PJ, Borbas C, et al: Effect of local medical opinion leaders on quality of care for acute myocardial infarction. JAMA 279: 1358–1363, 1998
Hiss RG, MacDonald R, David WR: Identification of physician educational influentials in small community hospitals. Res Med Educ 17: 283–288, 1978
Greer AL: The state of the art versus the state of the science: the diffusion of new medical technologies into practice. Int J Technol Assess Health Care 4: 5–26, 1988
Guadagnoli E, Shapiro CL, Gurwitz JH, Silliman RA, Weeks JC, Borbas C, et al: Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer. J Clin Oncol 15: 2338–2344, 1997
Guadagnoli E, Weeks JC, Shapiro CL, Gurwitz JH, Borbas C, Soumerai SB: The use of breast conserving surgery for treatment of early-stage breast cancer. J Clin Oncol 16: 101–106, 1998
Guadagnoli E, Shapiro CL, Weeks JC, Gurwitz JH, Borbas C, Soumerai SB: The quality of care for treatment of early-stage breast cancer: is it consistent with national guidelines? Cancer 83: 302–309, 1998
Marascuilo LA, McSweeney M: Nonparametric and Distribution-free Methods for the Social Sciences. Wadsworth Publishing Company, Belmont, CA, 1977
Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS: Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 326: 1102–1107, 1992
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Guadagnoli, E., Soumerai, S.B., Gurwitz, J.H. et al. Improving discussion of surgical treatment options for patients with breast cancer: local medical opinion leaders versus audit and performance feedback. Breast Cancer Res Treat 61, 171–175 (2000). https://doi.org/10.1023/A:1006475012861
Issue Date:
DOI: https://doi.org/10.1023/A:1006475012861