Physicians’ adherence, attitudes, and perceived barriers to the Mexican breast cancer clinical practice guidelines (BCCPG).
Authors: Martinez-Cannon Bertha Alejandra , Soto Pérez de Celis Enrique , Erazo Valle-Solis Aura A , Arce-Salinas Claudia , Bargallo-Rocha Enrique , Bautista-Piña Verónica , Cervantes Guadalupe , Flores Balcázar Christian Haydeé , Lara Tamburrino María del Carmen , Lluch Ana , Maffuz-Aziz Antonio , Perez Sanchez Victor Manuel , Poitevin Adela , Salas-Gonzalez Efrain , Torrecillas Laura , Valero Vicente , Villaseñor-Navarro Yolanda , Cardenas Jesus 
Published: June 2022

e18669 Background: Adherence to BCCPG improves outcomes for patients with breast cancer. However, the implementation of international BCCPG may not be feasible in low- and middle-income countries, and a potential solution may be developing BCCPG adapted to local contexts. The National Consensus on Diagnosis and Treatment of Breast Cancer ( Colima Consensus, http://consensocancermamario.com) is the Mexican BCCPG. This study aimed at evaluating physicians’ uptake of the Colima Consensus and identifying barriers impacting adherence. Methods: A cross-sectional, 30-item survey exploring adherence, barriers, and attitudes towards the Colima Consensus was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Answers were collected between 06/21-09/21. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants’ characteristics, adherence, attitudes, and barriers. Results: Among 1553 physicians invited to participate, 439 (28%) completed the survey. Fifty-four percent were male, 66% were age 30-49 years, and 39% practiced in Mexico City. Twenty-six percent were surgical, 13% medical, and 10% radiation oncologists. Ninety-two percent reported using the Consensus to guide decision-making, 78% adhered to its recommendations, 89% agreed with its recommendations, and 94% believed it was applicable to their clinical practice. Regarding attitudes towards the Consensus, 90% agreed/strongly agreed with it being a good educational tool, 89% a reliable source of information, and 90% thought it improved quality of care. The most common barriers to adherence were lack of resources (54%) and logistical problems (29%). Physicians working with a multidisciplinary team were less likely to cite lack of resources as reason for non-adherence (p < 0.01). Forty percent reported using the Consensus as their only BCCPG. Surgical oncologists (p < 0.01), those practicing in public hospitals (p < 0.01), in institutions with local BCCPG (p < 0.01), with ≤5 new patients/month (p < 0.01), and not involved in research (p < 0.01) were more likely to use the Consensus as their only BCCPG. In multivariate analysis, being a surgical oncologist (OR 3.26, p < 0.01) and working in a public hospital (OR 2.12, p < 0.01) increased the odds of using the Consensus as the only BCCPG. Conclusions: We show high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion using it as their main BCCPG. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local BCCPG and suggest a need for the creation of stratified recommendations adapted to various healthcare settings.