Are there variations in adherence to colorectal cancer clinical guidelines depending on treatment place and recommendation novelty? The French EvaCCoR observational study - 18/06/19
, R. Guimbaud d, e, L. Digue f, g, I. Cirilo-Cassaigne f, V. Bousser f, E. Oum-Sack e, J. Goddard e, E. Bauvin e, C. Delpierre c, P. Grosclaude c, hthe EvaCCoR Group
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Highlights |
• | Our results supported higher overall proportions of guidelines-based practices for the former clinical recommendations than for the most recent. |
• | The largest between-centers differences in guidelines adherence were not find for the most recent recommendations. |
• | The mechanisms of guidelines-based practices diffusion are unclear and seem to depend on the type of recommendation. |
Summary |
Background |
Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients’ socioeconomic position (SEP)-related variation in CRC guidelines.
Methods |
All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients’ SEP was approached by an ecological social deprivation index.
Results |
We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices.
Conclusion |
Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Adherence to guidelines, Between-center variation, Observational study, Colorectal cancer management, Social inequality in health
Mappa
Vol 43 - N° 3
P. 346-356 - Giugno 2019 Ritorno al numero
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