Elective surgical referral guidelines : background educational material or essential shared decision making tool? : a survey of GPs' in England
Blundell, N., Taylor-Phillips, Sian, Spitzer, D., Martin, Steven, Forde, I. and Clarke, Aileen. (2011) Elective surgical referral guidelines : background educational material or essential shared decision making tool? : a survey of GPs' in England. BMC Family Practice, Vol.12 (No.1). p. 92. ISSN 1471-2296
WRAP_Taylor_Phillips_1471-2296-12-92.pdf - Published Version
Official URL: http://dx.doi.org/10.1186/1471-2296-12-92
Background: To investigate general practitioners’ (GPs’) attitudes to guidelines for elective surgical referral in
England. To understand their use of guidelines, and attitudes to shared decision making in the referral decision.
Methods: A questionnaire was developed which investigated attitudes to and use of guidelines. It was given to a
stratified random sample 30% (n = 310) drawn from GP lists of 10 English health districts (primary care trusts
(PCTs)). GPs were invited to respond online, by telephone, fax or post. Data were analysed using descriptive
statistics and backwards stepwise logistic regression.
Results: Responses were representative of GPs in England, but (despite up to 6 contacts per non-responder) the overall
response rate was 41.6% (n = 129; with the range across PCTs of 25-61%). Most responding GPs indicated support for
referral guidelines but 18% reported that they had never used them. Less than three per cent reported use for most or
all referral decisions. The odds of using guidelines decreased with increasing age, with a ten year increase in age
associated with halving odds of use (OR = 0.53, 95%CI = 0.29-0.90). Over 50% of GPs wanted good access to electronic
guidelines with expert information and advice on guideline availability. Almost all (>89%) GPs agreed with sharing
referral decisions with patients. Female doctors (OR = 5.2, 95%CI: 1.02-26.3) were more likely to agree with this than
male GPs as were those working in larger compared to small or single handed practices (OR = 5.3, 95%CI: 1.4-19.9).
Conclusions: This group of responding GPs was supportive of guidelines but used them in different ways. Referral
guidelines should have an educational component for background reading; include key messages for
internalisation and application; and incorporate mechanisms to facilitate accessibility and appropriate shared
decision making with patients.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RD Surgery|
|Divisions:||Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Surgery, Elective -- Decision making, Physicians (General practice) -- Attitudes|
|Journal or Publication Title:||BMC Family Practice|
|Publisher:||BioMed Central Ltd.|
|Official Date:||30 August 2011|
|Page Range:||p. 92|
|Access rights to Published version:||Open Access|
|Funder:||National Institute for Health Research (Great Britain) (NIHR)|
|Grant number:||08/1310/072 (NIHR)|
1. Coulter A: The Autonomous Patient: Ending Paternalism in Medical Care.
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