Table 2

Surgeon perceptions of total mesorectal excision and the QIRC strategy*

PerceptionEarly adopters, n = 18Late adopters, n = 13Overallp value
Comparative advantage
 QIRC strategy was more effective compared with other continuing medical education initiatives8369770.41
 QIRC workshop was useful in presenting the principles and evidence for TME898387> 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.4150450.72
 Operative demonstration was effective in demonstrating TME techniques7290790.38
 Postoperative questionnaire was effective in prompting surgeons to revisit key steps in the intraoperative process of TME surgery7755680.41
 Audit and feedback was effective in encouraging surgeons to self-examine surgical decision-making or to request an operative demonstration565656> 0.99
 Great advantage with TME over traditional techniques of rectal cancer surgery for
  Aggressiveness of the oncologic resection788079> 0.99
  Rates of sphincter preservation656464> 0.99
  Rates of local recurrence829085> 0.99
  Rates of distant recurrence1350280.08
 No improvement in TME surgery techniques compared with pre-trial surgery techniques1862370.023
Compatibility with values
 The various aspects of the QIRC Trial were delivered in a supportive manner9485900.56
 Participation in an operative demonstration was a positive experience899089> 0.99
 TME is more compatible than traditional techniques in achieving cure899290> 0.99
 TME is more compatible than traditional techniques in preserving patient quality of life6792770.19
 My office staff found involvement in the QIRC trial not at all burdensome7285770.67
 I found my personal involvement in the QIRC trial not at all burdensome9485900.56
 The overall process of arranging and carrying out the demonstration went smoothly889089> 0.99
 TME rectal cancer surgery technique is more technically difficult than traditional techniques of rectal cancer surgery222323> 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).