Background: Diagnosis and surgical treatment decision making for breast cancers has become increasingly complex. Recently, Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of breast cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants of their implementation nationally. Methods: This study was undertaken in two parts-(1) National survey of breast cancer surgeons to assess the perceived extent of implementation of these standards in their institution and province; (2) Formation of a focus group with a representative sample of breast surgeons across Canada to further understand the barriers and facilitators towards future breast standards implementation. Results: 35 surgeons participated in the survey: 66% were from community hospitals. There were four categories of standards that were the most significantly lacking across the country-(a) processes related to quality assurance, (b) turnaround time for pathology results (c) psychosocial and health-related support for the breast cancer patient and (d) breast reconstruction for patients undergoing mastectomy. The focus group included participants from all ten Canadian provinces. For each standard, the 134 determinants fell into three main categories-individual physician (n = 27, 20%); organizational (n = 46, 34%), and system (n = 61, 46%). While specific determinants were present for each category, surgical standards were more likely to be implemented in practice if (1) they aligned with organizational priorities standards; (2) the individual physicians or physician groups were accountable to the organization and/or cancer jurisdiction regarding compliance with the standard; and (3) if infrastructure or resources existed within the organization or system for the reliable collection of relevant, meaningful, practice changing data combined with the capability of benchmarking, peer-peer comparisons and timely feedback to the surgeons. Conclusion: The results of this study demonstrated variation, barriers and opportunities for the national implementation of CPAC's breast cancer surgery standards and identified determinants of high-quality breast surgical care delivery.

中文翻译：

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加拿大乳腺癌手术治疗国家标准的实施：差距、障碍、促成因素和机会

背景：乳腺癌的诊断和手术治疗决策变得越来越复杂。最近，加拿大抗癌合作组织 (CPAC) 发布了泛加拿大循证手术标准，用于护理乳腺癌患者。进行这项研究是为了评估目前在实践中满足这些标准的程度，并进一步了解在全国范围内实施这些标准的决定因素。方法：本研究分两部分进行：（1）全国乳腺癌外科医生调查，以评估其所在机构和省份对这些标准的实施程度；(2) 与加拿大各地乳房外科医生的代表性样本组成焦点小组，以进一步了解未来乳房标准实施的障碍和促进因素。结果：35 名外科医生参与了调查：66% 来自社区医院。全国范围内最缺乏的有四类标准——(a) 与质量保证相关的流程，(b) 病理结果的周转时间 (c) 对乳腺癌患者的心理和健康相关支持，以及 (d) ) 接受乳房切除术的患者进行乳房重建。焦点小组包括来自加拿大所有十个省的参与者。对于每个标准，134 个决定因素分为三个主要类别——个体医生（n = 27, 20%）；组织 (n = 46, 34%) 和系统 (n = 61, 46%)。虽然每个类别都有特定的决定因素，但如果 (1) 符合组织优先级标准，则手术标准更有可能在实践中得到实施；(2) 个别医师或医师团体对组织和/或癌症管辖区对标准的遵守情况负责；(3) 组织或系统中是否存在基础设施或资源，用于可靠地收集相关的、有意义的、实践变化的数据，并结合基准、同行比较和及时反馈给外科医生的能力。结论：本研究的结果证明了 CPAC 乳腺癌手术标准在全国实施的变化、障碍和机会，并确定了高质量乳房手术护理的决定因素。(3) 组织或系统中是否存在基础设施或资源，用于可靠地收集相关的、有意义的、实践变化的数据，并结合基准、同行比较和及时反馈给外科医生的能力。结论：本研究的结果证明了 CPAC 乳腺癌手术标准在全国实施的变化、障碍和机会，并确定了高质量乳房手术护理的决定因素。(3) 组织或系统中是否存在基础设施或资源，用于可靠地收集相关的、有意义的、实践变化的数据，并结合基准、同行比较和及时反馈给外科医生的能力。结论：本研究的结果证明了 CPAC 乳腺癌手术标准在全国实施的变化、障碍和机会，并确定了高质量乳房手术护理的决定因素。