title: Adoption of surgical innovations: factors influencing use of sentinel lymph node biopsy for breast cancer.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) has been unevenly adopted into practice in Canada. In this qualitative study, the authors explored individual, institutional, and policy factors that may have influenced SLNB adoption. This information will guide interventions to improve SLNB implementation.
  
  
  METHODS
  Qualitative methodology was used to examine factors influencing SLNB adoption. Grounded theory guided data collection and analysis. Semistructured interviews were based on Roger's diffusion of innovation theory. Purposive and snowball sampling was used to identify participants. Semistructured telephone interviews were conducted with urban, rural, academic, and community health care providers and administrators to ensure all perspectives and motivations were explored. Two individuals independently analyzed data and achieved consensus on emerging themes and their relationship.
  
  
  RESULTS
  A total of 43 interviews were completed with 21 surgeons, 5 pathologists, 7 nuclear medicine physicians, and 10 administrators. Generated themes included awareness of SLNB with the exception of some administrators, acknowledged advantage of SLNB, SLNB compatibility with beliefs regarding axillary staging, acknowledgment that SLNB was a complex innovation to adopt, extensive trialing of SLNB prior to adoption, observable benefits with SLNB, acknowledgment that hospital-level administrative support enabled adoption, desire for a provincial policy supporting SLNB to assist in hospital-level adoption, requirement of a local high-volume breast surgery champion who communicated extensively with team to facilitate local adoption, and need for credentialing of SLNB to ensure quality.
  
  
  CONCLUSIONS
  SLNB is a complex innovation to adopt. Successful adoption was assisted by a high-volume breast cancer surgical champion, interprofessional communication, and administrative support.
authors: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. frances.wright@sunnybrook.ca
authors: Frances C
authors: FC
authors: Wright
authors: Anna R
authors: AR
authors: Gagliardi
authors: Novlette
authors: N
authors: Fraser
authors: May Lynn
authors: ML
authors: Quan
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000473:pathology*; D002170:Canada; D002985:Clinical Protocols; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*