Surgeons' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer

Objective: To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer (the Guidelines) and their views about and use of the accompanying Consumer's guide. Design: Cross-sectional telephone survey. Participants and setting: Surgeons throughout Australia who manage breast cancer, designated as 'breast' or 'general' (members or non-members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and 'urban' or 'rural'. Results: Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelines and believed they were useful in improving women's management and wellbeing, easy to understand, evidence-based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that 'women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting'. In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%, P < 0.001). Only 37% of surgeons routinely gave the Consumer's guide to all or more than half their patients. Conclusions: Surgeons are generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.