Assessing the effectiveness of computerised dissemination of the 'NHMRC clinical guidelines for the management of early breast cancer': baseline report

In 1995, the National Health and Medical Research Council (NHMRC) launched the “Clinical Guidelines for the Management of Early Breast Cancer” (1). These guidelines aimed to provide breast cancer specialists with evidence-based information and recommendations for best practice in relation to the management of women with early stage breast cancer. It was intended that the NHMRC guidelines be adopted by surgeons, medical oncologists, radiotherapists, general practitioners and other health care providers involved in the management of women with early breast cancer. The next step in the implementation of the NHMRC guidelines is their effective dissemination to relevant health care providers. Relatively little is known about how best to encourage the implementation of clinical practice guidelines. A recent review of the effectiveness of guidelines at affecting clinical practice concluded that more active methods of dissemination, such as the use of computer prompting or reminder and feedback systems were more effective than simple postal dissemination of guidelines (2). However, no previous studies have involved breast cancer care guidelines. Therefore, this project aimed to assess the effectiveness of a computerised method of disseminating the NHMRC Guidelines for the Management of Early Breast Cancer. For the sake of brevity, these will be referred to as "the Guidelines" throughout this report. More specifically, the study aimed to assess the effectiveness of printed feedback from an interactive touchscreen computer program at increasing the proportion of medical oncology patients with early breast cancer who are treated in accordance with the Guidelines. The study focused on providing tools to assist medical oncologists in providing a level of care as outlined by the NHMRC, by accessing the recommendations contained in the Guidelines. This study provided an opportunity to explore one strategy which could potentially be effective at implementing guidelines in a clinical setting, while also attempting to ensure all women diagnosed with early breast cancer receive optimal treatment. A subset of the Guidelines considered most relevant to medical oncologists and their patients have been used as outcome measures, indicating the interactive computer program’s effectiveness. The acceptability of the interactive computer program, to patients and medical oncologists, was also assessed in study, although results have not been presented in this report. The aims of this report were to document the development of the project and to report on the 5 baseline levels of treatment in accordance with the Guidelines. This report presents data collected for the baseline period only.