PERCEPTIONS AMONG GASTROENTEROLOGISTS AND SURGEONS OF NEW NATIONAL RECOMMENDATIONS FOR PREOPERATIVE ENDOSCOPIC LOCALIZATION OF COLORECTAL NEOPLASMS
Garrett Johnson*, Malcolm B. Doupe, Ramzi Helewa, Kathryn Sibley, Kristin Reynolds, Harminder Singh
Community Health Sciences, University of Manitoba Max Rady College of Medicine, Winnipeg, MB, Canada
Background: Many patients undergo a repeat endoscopy before surgery for colorectal neoplasms. This occurs primarily if lesion location was poorly documented, or the tumor was inadequately marked during the index scope. However, repeat endoscopy delays surgery and puts patients at risk of colonoscopy-related complications. New consensus-derived recommendations for localizing and documenting colorectal lesions were recently developed. The purpose of this study was to identify barriers and facilitators to using these new guidelines according to providers in a single mid-sized Canadian city. Methods: Gastroenterologists and surgeons who treat colorectal neoplasms in Winnipeg, MB, Canada, were contacted. Participants were introduced to the new guideline, shown an infographic summary, and were asked for their perspectives according to a semi-structured script. The consolidated framework for implementation research (CFIR) was used to guide data collection. A qualitative directed content analysis was used to determine the relevance of the CFIR constructs to participants' perspectives. Results: 9 surgeons and 11 gastroenterologists contributed. 60% work primarily in an academic practice. 20% were female. 78% of the participating surgeons perform colonoscopy in their elective practice. There were 6 major barriers. Participants required access to more educational materials to facilitate usage, such as print outs, and additional electronic synoptic endoscopy report items. There was a lack of familiarity with the evidence basis for some recommendations. No formal existing feedback processes relating to guideline use were available. Neither external nor internal organizational incentives for guideline compliance exist. Finally, funds/resources to support addition of missing components were currently inaccessible. However, there were many facilitators. Implementation was seen as advantageous compared to alternate solutions, or maintaining the status quo. The guideline was perceived as both highly compatible with local practices and skills, while also being adaptable. The simplicity of the recommendations as well as the excellent design quality and packaging were also strengths. The local central intake organizational structure for endoscopy, interdisciplinary communication networks, and the learning environment were all facilitators. Finally, participants viewed the decision to apply the guideline as a homegrown initiative, which was well-regarded. Conclusions: We identified specific barriers and facilitators to implementing new recommendations for documenting and marking colorectal neoplasms detected at endoscopy. These findings can be mapped to evidence-based, or expert-recommended practices for implementing change to design context-specific interventions to enhance guideline use and to ultimately reduce unnecessary repeat preoperative endoscopies.
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