Bertha Alejandra Martinez-Cannon1, Enrique Soto-Perez-de-Celis2, Aura Erazo Valle-Solis3, Claudia Arce-Salinas4, Enrique Bargallo-Rocha4, Veronica Bautista-Piña5, Guadalupe Cervantes-Sanchez6, Christian Haydeé Flores-Balcázar7, Maria Del Carmen Lara Tamburrino8, Ana Lluch9, Antonio Maffuz-Aziz10, Victor Manuel Pérez-Sánchez11, Adela Poitevin-Chacón12, Efraín Salas-González13, Laura Torrecillas Torres6, Vicente Valero14, Yolanda Villaseñor-Navarro15, Jesús Cárdenas-Sánchez16. 1. Hematology-Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. 2. Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Secc 16, Tlalpan, 14080, Mexico City, Mexico. enriquesotopc@yahoo.com. 3. Neoplastic and Proliferative Disorders Division, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico. 4. Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico. 5. Instituto de Enfermedades de la Mama FUCAM, Mexico City, Mexico. 6. Department of Medical Oncology, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico. 7. Radiotherapy and Medical Physics Service, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. 8. Breast Imaging, CT Scanner del Sur, Mexico City, Mexico. 9. Medical Oncology Unit, Centro de Investigacion Biomedica en Red de OncologiaGEICAM Spanish Breast Cancer Group, Hospital Clinico Universitario de Valencia, Biomedical Research Institute INCLIVA, Universidad de Valencia, CIBERONC-ISCIII, Valencia, Spain. 10. Department of Surgical Oncology, American British Cowdray Medical Center, Mexico City, Mexico. 11. Department of Surgical Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico. 12. Department of Radiation Oncology, Medica SUR, Mexico City, Mexico. 13. Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente IMSS, Guadalajara, Mexico. 14. Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 15. Subdireccion de Servicios Auxiliares de Diagnostico Y Tratamiento, Instituto Nacional de Cancerologia, Mexico City, Mexico. 16. Instituto Estatal de Cancerologia, Colima, Mexico.
Abstract
BACKGROUND: Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians' adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. METHODS: A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants' characteristics, adherence, attitudes, and barriers. RESULTS: Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0-5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2-3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. CONCLUSIONS: We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines.
BACKGROUND: Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians' adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. METHODS: A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants' characteristics, adherence, attitudes, and barriers. RESULTS: Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0-5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2-3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. CONCLUSIONS: We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines.
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