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Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions.

RATIONALE, AIMS AND OBJECTIVES
To explore the responses of primary health care professionals to guidelines in general, and to the UK national guidelines on the management and referral of women with breast conditions in particular.


METHODS
Qualitative study using practice-based, semistructured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practice; fifteen of the 34 study practices were audio-taped. Groups comprised the available partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses 51% attended. In all, 86 professionals attended the meetings.


RESULTS
A number of areas for comment arose consistently in each discussion. Guidelines in general were welcomed, although there was more support for evidence-based than consensus-based guidelines. The breast lump guideline was also welcomed, participants commenting that it was concordant with current practice. The breast pain guideline was more contentious, participants reflecting that it recommended more primary care management than was usual, and fell outside the experience and confidence of doctors or the expectations of patients. Participants felt it did not incorporate psychosocial factors into recommended management, despite this being an important part of primary care management.


CONCLUSIONS
There are concerns about consensus guidelines and doubts about the applicability of the breast pain guideline in this complex management area. The failure of these guidelines to address patient anxiety may limit their implementation.