Surgeons' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer.

OBJECTIVE: To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer (the Guidelines) and their views about and use of the accompanying Consumer's guide. DESIGN: Cross-sectional telephone survey. PARTICIPANTS AND SETTING: Surgeons throughout Australia who manage breast cancer, designated as "breast" or "general" (members or non-members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and "urban" or "rural". RESULTS: Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelines and believed they were useful in improving women's management and wellbeing, easy to understand, evidence-based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that "women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting". In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%; P < 0.001). Only 37% of surgeons routinely gave the Consumer's guide to all or more than half their patients. CONCLUSIONS: Surgeons are generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.

Emergency contraception. General practitioner knowledge, attitudes and practices in New South Wales.

OBJECTIVES: To assess the knowledge, attitudes and practices of general practitioners in New South Wales regarding the provision of emergency contraception. DESIGN: Randomised group comparison of 100 rural and 100 urban general practitioners (GPs) by questionnaire. RESULTS: Eighty-four rural and 76 urban GPs responded. More rural GPs were knowledgeable about emergency contraception than urban GPs (95% v. 78%), and more women knew about it than men. More urban GPs frequently prescribed emergency contraception than rural GPs (26% v. 6%) and female GPs prescribed it more readily than male GPs (22% v. 12%). There was great variation in the regimens prescribed, especially among rural GPs. Twenty-five per cent of urban GPs and 31% of rural GPs did not offer women information about emergency contraception, while 16% of both groups included such information in any discussion about contraceptive options, and 18% gave information only if requested by the woman. More than 60% of the GPs would provide information about emergency contraception as a back-up to use of barrier methods. CONCLUSIONS: The sex, attitude and knowledge of the GPs influence the likelihood of women being made aware of or being given emergency contraception in NSW. There is a need to further educate both the public and practitioners about emergency contraception.

PIP: In New South Wales, Australia, 76 urban general practitioners (GPs) and 84 rural GPs completed a questionnaire designed to determine their knowledge, attitude, and prescribing practices concerning emergency contraception. Rural GPs were more likely to know about emergency contraception than urban GPs (95% vs. 78%). Yet urban GPs were more likely than rural GPs to receive many requests for emergency contraception (25% vs. 6%; p = 0.018) and to prescribe it often (26% vs. 6%; p = 0.009). Female GPs not only were more likely than male GPs to know about emergency contraception but also to prescribe it (22% vs. 12%; p = 0.009). 58% of urban GPs and 52% of rural GPs prescribed the Yuzpe regimen (100 mcg ethinyl estradiol + 500 mcg levonorgestrel within 72 hours of unprotected intercourse and repeated 12 hours later). The GPs (particularly rural GPs) varied greatly in the emergency contraception regimens prescribed. These prescribed variable regimens, other than the Yuzpe regimen, have not been adequately studied, however. 28% of urban GPs and 31% of rural GPs did not automatically provide information about emergency contraception. 16% of both groups always included emergency contraception in discussions about contraceptive options. 18% only provided this information on request. 60% of all GPs would provide information about emergency contraception as a back-up to barrier methods. These findings suggest the need for GPs and the public to become educated about emergency contraception. Pharmaceutical companies should provide a specific emergency contraceptive package so that regulators can approve it and that normal marketing can begin. Ideally, a prepackaged postcoital regimen should be available over-the-counter.