Surgeon perceptions of total mesorectal excision and the QIRC strategy*
| 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).