Radiotherapy in rectal cancer: is it time for change? A qualitative analysis of the national questionnaire survey of members of ACPGBI on preliminary CRO7 results.
BACKGROUND
A national questionnaire survey on management of rectal cancer suggested that despite the evidence of the CRO7 trial supporting the use of neoadjuvant short-course radiotherapy for operable rectal cancer, approximately two-thirds of consultant surgeons in the UK still have to implement this treatment regime routinely. However, 39% of surgeons have changed their practice following the early dissemination of trial results. Change in clinical practice is driven by a number of factors.


OBJECTIVE
To determine factors influencing changing clinical practice in the use of radiotherapy in rectal cancer.


METHODS
A 14-item questionnaire was designed to inquire into the current management strategy of operable rectal cancer and the possible role of neoadjuvant radiotherapy. A postal questionnaire survey was sent to all the active consultant members of the Association of Coloproctology of Great Britain and Ireland. Data for this article have been drawn from the subset of results constituting the comments section in the questionnaire. Qualitative methodology was adopted to analyse the comments section.


RESULTS
Of 400 questionnaires, 200 (50%) were returned completed. Of these, only 52 (26%) surgeons completed the comments section. Themes that emerged from thematic analysis were: Patient groups, Treatment, Evidence-based practice (EBP), Professional consensus and Service provisions. The derived outcomes were: individualization of treatment, safer and less harmful treatment, increased role of multidisciplinary teams, need to increase awareness of the current evidence-based literature, develop protocols and guidelines along with shortening the delay in implementing EBP and good service provisions.


CONCLUSIONS
In conclusion, change in practice is a slow and complex process influenced not only by data and scientific evidence, but also by a combination of other factors. Some of them are Clinical decision making, EBP/Education, Research Translation and Organizational factors with Infrastructure/Resources. Some of the above-mentioned conclusions will aid the policy makers and the opinion leaders in the National Health Service (NHS).
Srinivasaiah
N
N
Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
Monson
J R
JR
D003657:Decision Making; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D013502:General Surgery / Q000193:education; D006801:Humans; D020360:Neoadjuvant Therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011795:Surveys and Questionnaires; D006113:United Kingdom