title: Lake Superior Rural Cancer Care Project, Part III: provider practice.
abstract: OBJECTIVE
  Effective methods that encourage rural primary-care physicians to adopt state-of-the-art cancer-management practices are needed. The purpose of this study was to evaluate educational and systems strategies to improve rural primary-care physicians' cancer practice behaviors.
  
  
  METHODS
  The Lake Superior Rural Cancer Care Project was a group-randomized, controlled trial conducted with 18 rural communities in the North Central United States over 4 years. Although the unit of analysis was the community, the subjects were 104 primary-care physicians and 2089 rural patients with cancer. The intervention was educational and comprised systems strategies that targeted rural primary-care physicians and their healthcare delivery systems. The outcome measures reported here were physician practice behaviors regarding cancer diagnosis, staging, treatment, clinical trial participation, and post-treatment surveillance.
  
  
  RESULTS
  The intervention significantly improved 5 of the 37 cancer practice end points. The overall result of the study did not support the majority of the study hypotheses. Because 16 practice end points were found to be at acceptable performance levels, the possibility of a measurable intervention effect was limited.
  
  
  CONCLUSIONS
  Earlier, the authors reported the results of the intervention on providers' cancer management knowledge, which showed significant improvement. The present study findings demonstrated that improving provider knowledge does not necessarily improve practice performance. Changing practice behaviors requires much more effort. Furthermore, interventions found to be effective in other diseases, types of providers, or settings may not work on rural providers for cancer management.
authors.affiliation: Division of Education and Research, St. Mary's/Duluth Clinic Health System, and Clinical Professor, University of Minnesota Duluth, School of Medicine, Duluth, MN 55805, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Elliott
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Elliott
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Regal
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Renier
authors.forename: Irina V
authors.initials: IV
authors.lastname: Haller
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Crouse
authors.forename: Martha T
authors.initials: MT
authors.lastname: Witrak
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Jensen
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D009369:Neoplasms / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*