title: Challenges in multidisciplinary cancer care among general surgeons in Canada.
abstract: BACKGROUND
  While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings.
  
  
  METHODS
  General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses.
  
  
  RESULTS
  The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care.
  
  
  CONCLUSIONS
  General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. anna.gagliardi@sunnybrook.ca
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.forename: Frances C
authors.initials: FC
authors.lastname: Wright
authors.forename: Dave
authors.initials: D
authors.lastname: Davis
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery / Q000379:methods* / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000458:organization & administration; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000601:surgery / Q000628:therapy*; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration; D011795:Surveys and Questionnaires