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Do Australian Surgeons Know the Scientific Evidence?

Jeanette E. Ward, MBBS,MHPEd,PhD,FAFPHM; Melina Gattellari, BSc,MPH; Michael J. Solomon, MSc,FRACS

Arch Surg. 2002;137:1389-1394.

Hypothesis  Not all Australian surgeons are aware of the status of the current evidence for the management of colorectal cancer.

Design  Postal survey of Fellows of the Royal Australasian College of Surgeons.

Participants  One hundred ninety-five surgeons (127 general surgeons and 68 subspecialist colorectal surgeons) from a response fraction of 89%.

Main Outcome Measures  Overall awareness score for 23 clinical recommendations and a subscore for 10 of these for which evidence is compelling rather than inconclusive (9 for and 1 against incorporation in clinical practice).

Results  Although no surgeon indicated the status of the evidence correctly for all 23 items, 61% of respondents correctly identified 12 or more items. Surgeons who practiced in capital cities had significantly higher scores than those who practiced outside cities ( = .16; B = 1.01; 95% confidence interval [CI], 0.14-1.89; P = .02). Surgeons who had been in practice for relatively more years had significantly lower scores than younger surgeons ( = -.17; B = -0.059; 95% CI, -0.11 to 0.01; P = .02). Surgeons involved in research had significantly higher scores ( = .18; B = 1.11; 95% CI, 0.23-1.99; P = .01), as did those respondents who had been involved in guideline development ( = .18; B = 1.42; 95% CI, 0.24-2.63; P = .02). Subscores showed a significantly greater awareness of compelling evidence (level I or level II) (P<.001). There was no relationship between awareness of the evidence for adjuvant therapy and surgeons' perceptions of the usefulness of guidelines about this aspect of clinical management.

Conclusions  Our innovative preguidelines survey has shown that not all surgeons were aware of the evidence underpinning the management of colorectal cancer, affirming the need for guidelines. Predictors of low awareness could be used to target efforts to disseminate and implement guidelines.

From the Division of Population Health, Southwestern Sydney Area Health Service (Prof Ward and Ms Gattellari); and the Surgical Outcomes Research Centre, Central Sydney Area Health Service and the Department of Surgery, University of Sydney (Assistant Prof Solomon), Sydney, Australia.

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