Article Figures & Tables
Figures
- Fig. 1
Classic diffusion of an innovation curve.1
- Fig. 2
Curve for uptake over time for the operative demonstrations.
Tables
- Table 1
Percentage of participation in QIRC strategy interventions for early and late adopters
Participation Early adopters, n = 27 Late adopters, n = 29 Overall p value Provided written consent 100 83 91 0.024 Attended workshop 89 52 70 0.003 Operative demonstrations Requested at least 1 100 45 71 < 0.001 Participated in at least 1 96 45 70 < 0.001 Returned at least 1 postoperative questionnaire 89 69 79 0.07 QIRC = Quality Initiative in Rectal Cancer trial.
Perception Early adopters, n = 18 Late adopters, n = 13 Overall p value Comparative advantage QIRC QIRC strategy was more effective compared with other continuing medical education initiatives 83 69 77 0.41 QIRC workshop was useful in presenting the principles and evidence for TME 89 83 87 > 0.99 Opinion leader was useful in being the local ambassador for the study, providing feedback regarding the QIRC trial, and providing assistance in completing operative questionnaires. 41 50 45 0.72 Operative demonstration was effective in demonstrating TME techniques† 72 90 79 0.38 Postoperative questionnaire was effective in prompting surgeons to revisit key steps in the intraoperative process of TME surgery 77 55 68 0.41 Audit and feedback was effective in encouraging surgeons to self-examine surgical decision-making or to request an operative demonstration‡ 56 56 56 > 0.99 TME Great advantage with TME over traditional techniques of rectal cancer surgery for Aggressiveness of the oncologic resection 78 80 79 > 0.99 Rates of sphincter preservation 65 64 64 > 0.99 Rates of local recurrence 82 90 85 > 0.99 Rates of distant recurrence 13 50 28 0.08 No improvement in TME surgery techniques compared with pre-trial surgery techniques 18 62 37 0.023 Compatibility with values QIRC The various aspects of the QIRC Trial were delivered in a supportive manner 94 85 90 0.56 Participation in an operative demonstration was a positive experience† 89 90 89 > 0.99 TME TME is more compatible than traditional techniques in achieving cure 89 92 90 > 0.99 TME is more compatible than traditional techniques in preserving patient quality of life 67 92 77 0.19 Complexity QIRC My office staff found involvement in the QIRC trial not at all burdensome 72 85 77 0.67 I found my personal involvement in the QIRC trial not at all burdensome 94 85 90 0.56 The overall process of arranging and carrying out the demonstration went smoothly† 88 90 89 > 0.99 TME TME rectal cancer surgery technique is more technically difficult than traditional techniques of rectal cancer surgery 22 23 23 > 0.99 QIRC = Quality Initiative in Rectal Cancer trial; TME = total mesorectal excision.
↵* Respondents answered using a 5-point Likert scale. Codes were collapsed for the analyses. Percentages based on positive responses (codes 1 and 2) versus neutral or negative responses (codes 3, 4 and 5).
↵† Percentages based only on respondents who participated in at least 1 operative demonstration (early adopters n = 18; late adopters n = 10).
↵‡ Percentages based only on respondents who were aware of the audit and feedback report (early adopters n = 9; late adopters n = 9).
Characteristic Early adopters, n = 18 Late adopters, n = 13 Overall p value Year of graduation, median 1984 1988 1984 0.13 Resources Operating room hours per wk, median 10 9 10 0.26 Endoscopy hours per wk, median 4 4 4 0.73 Cosmopolitan nature Annually attend 6–10 surgical conferences inside Ontario, % 28 31 29 0.46 Annually attend 1–5 surgical conferences outside Ontario, % 78 69 74 0.66 Other surgical innovations Attempted or performed a laparoscopic colon resection for benign or malignant disease in the last 12 months, % 56 62 58 0.74 Attitude* Positive opinion on the current direction of the health care system in Ontario, % 11 23 16 0.37 Positive opinion on the current direction of colorectal cancer surgery in Ontario, % 56 85 68 0.09 ↵* Respondents answered using a 5-point Likert scale. Codes were collapsed for the analyses. Percentages based on positive responses (codes 1 and 2) versus neutral or negative responses (codes 3, 4 and 5).
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