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 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.
Guadagnoli
E
E
Departmnent of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. guadagnoli@hcp.med.harvard.edu
Soumerai
S B
SB
Gurwitz
J H
JH
Borbas
C
C
Shapiro
C L
CL
Weeks
J C
JC
Morris
N
N
D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D003142:Communication; D005246:Feedback; D005260:Female; D013502:General Surgery; D006742:Hospital Bed Capacity; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D008910:Minnesota; D010353:Patient Education as Topic / Q000331:legislation & jurisprudence / Q000379:methods* / Q000706:statistics & numerical data; D010379:Peer Group; D010817:Physician-Patient Relations; D013647:Task Performance and Analysis; D014342:Truth Disclosure