NEW YORK – About half of veterans with low-risk prostate cancer receive imaging not called for in clinical guidelines, according to a new study.
The report, published in The Lancet journal Implementation Science, described an effort to identify and describe physician knowledge, attitudes, and practices related to the use of imaging to stage prostate cancer, as well as document patient attitudes and behaviors related to use of imaging.1
The study, led by researchers at the VA New York Harbor Healthcare System, also sought to compare responses across three VAMCs.
To explore patient and provider knowledge and behaviors relating to the use of imaging, the researchers conducted 39 semi-structured interviews total—including 22 interviews with patients with newly diagnosed with prostate cancer and 17 interviews with physicians caring for them—between September 2014 and July 2015 at three VAMCs representing a spectrum of inappropriate imaging rates.
Themes from patient interviews were categorized within four Theoretical Domains Framework (TDF) domains. Results indicated that:
- Patients reported little interest in staging as compared to disease treatment (goals), and many could not remember if they had imaging at all (knowledge).
- Patients tended to trust their doctor to make decisions about appropriate tests (beliefs about capabilities).
- Some patients expressed a minor concern for radiation exposure, but anxiety about cancer outcomes outweighed these fears (emotion).
At the same time, themes from physician interviews were categorized within five TDF domains: Most physicians self-reported that they know and trust imaging guidelines (knowledge) yet some were still likely to follow their own intuition, whether due to clinical suspicion or years of experience (beliefs about capabilities). Furthermore, physicians reported that medico-legal concerns, fear of missing associated diagnoses (beliefs about consequences), influence from colleagues who image frequently (social influences), and the facility where they practice influences rates of imaging (environmental context).
“Interviews with patients and physicians suggest that physicians are the primary (and in some cases only) decision-makers regarding staging imaging for prostate cancer,” study authors concluded. “This finding suggests a physician-targeted intervention may be the most effective strategy to improve guideline-concordant prostate cancer imaging.”
- Makarov DV, Sedlander E, Braithwaite RS, Sherman SE, Zeliadt S, Gross CP, Curnyn C, Shedlin M. A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer. Implement Sci. 2016 Sep 2;11(1):118. doi: 10.1186/s13012-016-0484-5. PubMed PMID: 27590603; PubMed Central PMCID: PMC5010696.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.