INTRODUCTION
Total mesorectal excision vs. traditional surgical techniques may lead to improved rates of permanent colostomy, local tumor recurrence, and survival for patients undergoing major rectal cancer operations. We developed the surgeon-directed, multipronged Quality Initiative in Rectal Cancer strategy to encourage surgeons to use total mesorectal excision techniques.
METHODS
The Quality Initiative in Rectal Cancer strategy interventions included a workshop, an operative demonstration of total mesorectal excision, and a postoperative questionnaire. The design of the strategy was informed by the industrial theory principles of continuous quality improvement. We assessed the logistics of implementing the strategy and the attitudes of surgeons toward the strategy through a pilot study at three community hospitals in the Central-West region of Ontario.
RESULTS
Seventeen of 19 surgeons participated in a workshop, and 12 of 17 workshop participants received at least one operative demonstration of total mesorectal excision. Ten of 11 surgeons who completed a postoperative questionnaire indicated their traditional approach to rectal cancer surgery varied with that of the operative demonstration. The attitudes of surgeons toward the Quality Initiative in Rectal Cancer strategy were positive. For the time periods before and after the pilot study, there was a trend toward a lower rate of permanent colostomy among patients treated by surgeons who participated in both the workshop and an operative demonstration of total mesorectal excision.
CONCLUSION
The Quality Initiative in Rectal Cancer strategy may be an effective method of introducing optimal rectal cancer surgery techniques to a large group of practicing surgeons.
Similar content being viewed by others
REFERENCES
JK MacFarlane R Ryall RJ Heald (1993) ArticleTitleMesorectal excision for rectal cancer Lancet 341 457–60 Occurrence Handle10.1016/0140-6736(93)90207-W Occurrence Handle1:STN:280:ByyC28vnslc%3D Occurrence Handle8094488
Havenga K, Enker WE, DeRuiter MC, Welvaart K (1996) Anatomical basis of total mesorectal excision and preservation of the pelvic autonomic nerves. In: Soreide O, Norstein J, eds. Rectal cancer surgery: optimisation, standardisation, documentation. Berlin: Springer-Verlag, 134–42.
IJ Adam MO Mohamdee IG Martin et al. (1994) ArticleTitleRole of circumferential margin involvement in the local recurrence of rectal cancer Lancet 344 707–11 Occurrence Handle10.1016/S0140-6736(94)92206-3 Occurrence Handle1:STN:280:ByuA2MbjtFU%3D Occurrence Handle7915774
JV Reynolds WP Joyce J Dolan K Sheahan JM Hyland (1996) ArticleTitlePathological evidence in support of total mesorectal excision in the management of rectal cancer Br J Surg 83 1112–5 Occurrence Handle10.1046/j.1365-2168.1996.02330.x Occurrence Handle1:STN:280:ByiD383ps1Q%3D Occurrence Handle8869320
E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–46 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D Occurrence Handle11547717
AL Martling T Holm LE Rutqvist BJ Moran RJ Heald B Cedemark (2000) ArticleTitleEffect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project Lancet 356 93–6 Occurrence Handle10.1016/S0140-6736(00)02469-7 Occurrence Handle1:STN:280:DC%2BD3cvjtVensQ%3D%3D Occurrence Handle10963244
M Simunovic T To N Baxter et al. (2000) ArticleTitleHospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population J GI Surg 4 324–30 Occurrence Handle10.1016/S1091-255X(00)80083-9 Occurrence Handle1:STN:280:DC%2BD3czosFyisQ%3D%3D
LF Paszat MD Brundage PA Groome K Schulze WJ Mackillop (1999) ArticleTitleA population-based study of rectal cancer: permanent colostomy as an outcome Int J Radiat Oncol Biol Phys 45 1185–91 Occurrence Handle10.1016/S0360-3016(99)00327-2 Occurrence Handle1:STN:280:DC%2BD3c%2FnvVCksA%3D%3D Occurrence Handle10613311
CS McArdle D Hole (1991) ArticleTitleImpact of variability among surgeons on postoperative morbidity and mortality and ultimate survival BMJ 302 1501–5 Occurrence Handle1:STN:280:By6A3cfnsVM%3D Occurrence Handle1713087
RK Phillips R Hittinger L Blesovsky JS Fry LP Fielding (1984) ArticleTitleLocal recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture Br J Surg 71 12–6 Occurrence Handle1:STN:280:BiuD1c7jtVU%3D Occurrence Handle6689962
AD Oxman MA Thomson D David RB Haynes (1995) ArticleTitleNo magic bullets: a systematic review of 102 trials of interventions to improve professional practice Can Med Assoc J 153 1423–31 Occurrence Handle1:STN:280:BymD28jgtlU%3D
BS Mittman AL Siu (1992) Changing provider behavior: applying research on outcomes and effectiveness in health care SM Shortell UE Reinhardt (Eds) Improving health policy and management: nine critical research issues for the 1990’s Health Administration Press Ann Arbor 195–226
J Lomas (1993) ArticleTitleDiffusion, dissemination and implementation: who should do what? Ann N Y Acad Sci 703 226–35 Occurrence Handle1:STN:280:ByuB2cbotlI%3D Occurrence Handle8192299
J Lomas RB Haynes (1988) ArticleTitleA taxonomy and critical review of tested strategies for the application of clinical practice recommendations: from “official” to “individual” clinical policy Am J Prev Med 4 77–95 Occurrence Handle1:STN:280:By%2BA387mt1M%3D Occurrence Handle3079143
D Berwick A Godfrey J Roessner (1990) Curing health care—new strategies for quality improvement Jossey-Bass Publishers San Francisco
SB Kritchevsky BP Simmons (1991) ArticleTitleContinuous quality improvement. Concepts and applications for physician care JAMA 266 1817–23 Occurrence Handle10.1001/jama.266.13.1817 Occurrence Handle1:STN:280:By6A28nnsFY%3D Occurrence Handle1890711
MA Thomson O’Brien N Freemantle AD Oxman F Wolf DA Davis J Herrin (2003) Continuing education meetings and workshops: effects on professional practice and health care outcomes (Cochrane Review) The Cochrane library, issue 2 Update Software Oxford
MA Thomson O’Brien AD Oxman RB Haynes DA Davis N Freemantle EL Harvey (2003) Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes (Cochrane Review) The Cochrane library, issue 2 Update Software Oxford
ACKNOWLEDGMENT
The authors thank Sylvie Cornacchi, Research Coordinator, Surgical Outcomes Research Centre (SOURCE), Department of Surgery, Faculty of Health Sciences, McMaster University, for her assistance with the chart abstraction.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by the Hamilton Regional Cancer Centre Foundation, Hamilton Health Sciences Foundation
About this article
Cite this article
Simunovic, M., Paterson, C., Coates, A. et al. Pilot Study of the Quality Initiative in Rectal Cancer Strategy. Dis Colon Rectum 47, 1594–1598 (2004). https://doi.org/10.1007/s10350-004-0658-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0658-0