The impact of patient management guidelines on the care of breast, colorectal, and ovarian cancer patients in Italy

Roberto Grilli, Giovanni Apolone, Silvia Marsoni, Antonio Nicolucci, Paolo Zola, Alessandro Liberati

Research output: Contribution to journalArticle

Abstract

The impact of a national education program based on the dissemination of written guidelines for the treatment of breast, colorectal, and ovarian cancer was investigated in Italy. Through a survey of 770 physicians exploring their knowledge and attitudes and a review of medical records of 1,483 patients assessing current clinical practice, this study examined whether 1) the guidelines reached the target population of physicians, 2) they were effective in shaping doctors’ opinions, and 3) care patterns conformed with the guidelines. Overall, the net effect of the intervention appeared to be limited in terms of actual diffusion, attributable influence, and impact. As for diffusion, only 60%, 47%, and 44% of doctors were aware of breast, colorectal, and ovarian cancer guidelines, respectively. Although doctors who were aware of the guidelines had more appropriate opinions than those who were not, overall agreement with recommendations was often unsatisfactory. With reference to guidelines recommendations, quality of care was far from optimal, especially in relation to diagnosis and staging. Marked variations in compliance with recommendations emerged with values ranging from 37% to 89%, from 48% to 82%, and from 10% to 97% for breast, colorectal, and ovarian cancer, respectively, and this held true even in hospitals where the larger awareness of the guidelines might have been expected to result in better quality care. It was concluded that any thorough assessment of the impact of educational interventions should include a careful analysis of the strategy and process of dissemination. The availability of clinically relevant messages must also be realistically considered before deciding whether the “guidelines approach” is the strategy most likely to succeed.

Original languageEnglish
Pages (from-to)50-63
Number of pages14
JournalMedical Care
Volume29
Issue number1
Publication statusPublished - 1991

Fingerprint

Ovarian Neoplasms
Italy
Colorectal Neoplasms
cancer
Guidelines
Breast Neoplasms
management
physician
staging
Quality of Health Care
Educational Measurement
Physicians
Values
Health Services Needs and Demand
education
Medical Records
Education

Keywords

  • Breast cancer
  • Colorectal cancer
  • Educational intervention
  • Ovarian cancer

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

The impact of patient management guidelines on the care of breast, colorectal, and ovarian cancer patients in Italy. / Grilli, Roberto; Apolone, Giovanni; Marsoni, Silvia; Nicolucci, Antonio; Zola, Paolo; Liberati, Alessandro.

In: Medical Care, Vol. 29, No. 1, 1991, p. 50-63.

Research output: Contribution to journalArticle

Grilli, R, Apolone, G, Marsoni, S, Nicolucci, A, Zola, P & Liberati, A 1991, 'The impact of patient management guidelines on the care of breast, colorectal, and ovarian cancer patients in Italy', Medical Care, vol. 29, no. 1, pp. 50-63.
Grilli, Roberto ; Apolone, Giovanni ; Marsoni, Silvia ; Nicolucci, Antonio ; Zola, Paolo ; Liberati, Alessandro. / The impact of patient management guidelines on the care of breast, colorectal, and ovarian cancer patients in Italy. In: Medical Care. 1991 ; Vol. 29, No. 1. pp. 50-63.
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