title: Uptake of an innovation in surgery: observations from the cluster-randomized Quality Initiative in Rectal Cancer trial.
abstract: BACKGROUND
  Theory suggests the uptake of a medical innovation is influenced by how potential adopters perceive innovation characteristics and by characteristics of potential adopters. Innovation adoption is slow among the first 20% of individuals in a target group and then accelerates. The Quality Initiative in Rectal Cancer (QIRC) trial assessed if rectal cancer surgery outcomes could be improved through surgeon participation in the QIRC strategy. We tested if traditional uptake of innovation concepts applied to surgeons in the experimental arm of the trial.
  
  
  METHODS
  The QIRC strategy included workshops, access to opinion leaders, intraoperative demonstrations, postoperative questionnaires, and audit and feedback. For intraoperative demonstrations, a participating surgeon invited an outside surgeon to demonstrate optimal rectal surgery techniques. We used surgeon timing in a demonstration to differentiate early and late adopters of the QIRC strategy. Surgeons completed surveys on perceptions of the strategy and personal characteristics.
  
  
  RESULTS
  Nineteen of 56 surgeons (34%) requested an operative demonstration on their first case of rectal surgery. Early and late adopters had similar perceptions of the QIRC strategy and similar characteristics. Late adopters were less likely than early adopters to perceive an advantage for the surgical techniques promoted by the trial (p = 0.023).
  
  
  CONCLUSIONS
  Most traditional diffusion of innovation concepts did not apply to surgeons in the QIRC trial, with the exception of the importance of perceptions of comparative advantage.
authors.affiliation: The Department of Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ont., the Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Oncology, Faculty of Health Sciences, Juravinski Cancer Centre, Hamilton, Ont.
authors.forename: Marko
authors.initials: M
authors.lastname: Simunovic
authors.forename: Angela
authors.initials: A
authors.lastname: Coates
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Charles H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
mesh_terms: D006801:Humans; D010818:Practice Patterns, Physicians'; D012004:Rectal Neoplasms / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*; D035703:Therapies, Investigational