title: Association between surgeon characteristics and their preferences for guideline-concordant staging and treatment for rectal cancer.
abstract: BACKGROUND
  Rectal cancer guidelines recommend transrectal ultrasound or magnetic resonance imaging for locoregional staging and neoadjuvant chemoradiation therapy (CRT) for Stage II/III disease, but studies show these are underutilized. We examined how surgeon preferences align with guidelines or vary by training.
  
  
  METHODS
  Questionnaires on training, years of practice, and staging/treatment preferences were sent to surgeons practicing in Florida.
  
  
  RESULTS
  Of 759 surveys distributed, 321 (42%) responded; 158 were excluded because they were trainees, not treating rectal cancer, or not board certified/eligible. Among the remaining 163, 71% were general surgeons, 18% colorectal surgeons, and 11% surgical oncologists. Colorectal surgeons and surgical oncologists were more likely than general surgeons to prefer transrectal ultrasound/magnetic resonance imaging (79% vs 50%; P < .01), and neoadjuvant CRT (71% vs 45%; P < .01). Differences remained significant after adjusting for years in practice.
  
  
  CONCLUSIONS
  Increased focus on appropriate use of staging procedures and neoadjuvant CRT within general surgery training/educational programs is warranted.
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA; VA Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA. Electronic address: mary-charlton@uiowa.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.affiliation: Department of Nursing, VA Medical Center, Memphis, TN, USA.
authors.forename: Lorren R
authors.initials: LR
authors.lastname: Mattingly-Wells
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Marcet
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
authors.forename: Brenna C
authors.initials: BC
authors.lastname: McMahon Waldschmidt
authors.affiliation: Division of Gastrointestinal Surgery, Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Iowa College of Medicine, Iowa City, IA, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Cromwell
mesh_terms: D001291:Attitude of Health Personnel; D059186:Chemoradiotherapy, Adjuvant; D003107:Colorectal Surgery; D005431:Florida; D013502:General Surgery; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008495:Medical Oncology; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy; D066231:Surgeons / Q000523:psychology*
keywords: Guideline adherence; Neoadjuvant therapy; Rectal cancer