The impact of clinical audit and feedback on radiotherapy prescribing practices : a randomized controlled trial

Background: Evidence-based, clinical practice guidelines (CPGs) provide a framework for prescribing practices and patient management. A gap between CPGs and clinical practice often exists and may result in substandard patient care. Clinical audit and feedback (CA&F) is a demonstrated successful knowledge translation (KT) method that can positively impact change in practice in numerous clinical scenarios including adherence to CPGs. However, there has been low implementation of CA&F in oncology, and specifically in radiotherapy (RT) prescribing practices. We sought to identify the impact of a simple CA&F intervention on the proportion of recommended prescription use across six cancer centres in British Columbia (BC) by investigating five breast cancer clinical scenarios. Methods: Thirty-five radiation oncologists (ROs) were randomized to either be audited with feedback or audited alone (control). Patient data was obtained retrospectively for patients treated before and after intervention. The effect of feedback was measured by identifying the proportion of patients who received the recommended prescription before vs. after the feedback intervention, and a logistic regression model was used to predict odds ratio of using the recommended prescription as a result of CA&F. Results: A total of 8713 unique cases were identified, and the recommended prescription was used 75% of the time. Odds ratio of using the recommended prescription across five clinical scenarios was 0.78 (p=0.57), 0.87 (p=0.77), 0.90 (p=0.85), 0.93 (p=0.58), and 0.28 (p=0.36) respectively. Conclusion: There was no significant change in odds of utilizing the more evidence-based prescription, suggesting our simple CA&F intervention was not effective in changing prescribing practices. Further, ROs may have already been well informed of their prescribing patterns. A more complex CA&F intervention may be necessary in future quality assurance efforts to achieve a greater impact on radiotherapy prescribing practices.Medicine, Faculty ofGraduat