Variability in adherence to guidelines based management of nonmuscle invasive bladder cancer among Society of Urologic Oncology (SUO) members
| Autor: | Roger Li, Siamak Daneshmand, Jeffrey M. Holzbeierlein, Edward M. Messing, Justin T. Matulay, John L. Gore, Gary D. Steinberg, Stephen B. Williams, Jonathan J. Duplisea, Lawrence Karsh, James M. McKiernan, William Tabayoyong, Badrinath R. Konety, Ashish M. Kamat, Simon P. Kim, Courtney M Chang |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Urology Urinary Bladder 030232 urology & nephrology Urologic Oncology Medical Overuse Disease Cystectomy Medical Oncology Risk Assessment 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires Biomarkers Tumor Humans Medicine Statistical analysis Practice Patterns Physicians' Watchful Waiting Societies Medical Neoplasm Staging Evidence-Based Medicine Bladder cancer medicine.diagnostic_test business.industry Muscle Smooth Cystoscopy Guideline Targeted interventions medicine.disease Urinary Bladder Neoplasms Oncology 030220 oncology & carcinogenesis Family medicine Practice Guidelines as Topic Disease Progression Guideline Adherence Neoplasm Grading Neoplasm Recurrence Local business |
| Zdroj: | Urologic Oncology: Seminars and Original Investigations. 38:796.e1-796.e6 |
| ISSN: | 1078-1439 |
| Popis: | The American Urological Association (AUA) introduced evidence-based guidelines for the management of nonmuscle invasive bladder cancer (NMIBC) in 2016. We sought to assess the implementation of these guidelines among members of the Society of Urologic Oncology (SUO) with an aim to identifying addressable gaps.An SUO approved survey was distributed to 747 members from December 28, 2018 to February 2, 2019. This 14-question online survey (Qualtrics, SAP SE, Germany) consisted of 38 individual items addressing specific statements from the AUA NMIBC guidelines within 3 broad categories - initial diagnosis, surveillance, and imaging/biomarkers. Adherence to guidelines was assessed by dichotomizing responses to each item that was related to recommended action statement within the guidelines. Statistical analysis was applied using Pearson's chi-squared test, where a P-value of0.05 was considered statistically significant.A total of 121 (16.2%) members completed the survey. Members reported a mean of 71% guidelines adherence; adherence was higher for the intermediate- and high-risk subgroups (82% and 76%, respectively) compared to low-risk (58%). Specifically, adherence to guideline recommended cystoscopic surveillance intervals for low-risk disease differed based on clinical experience (60.9% [10 years] vs. 36.8% [≥10 years], P = 0.01) and type of fellowship training (55.2% [urologic oncology] vs. 28.0% [none/other], P = 0.02).Adherence to guidelines across risk-categories was higher for intermediate- and high-risk patients. Decreased adherence observed for low-risk patients resulted in higher than recommended use of cytology, imaging, and surveillance cystoscopy. These results identify addressable gaps and provide impetus for targeted interventions to support high-value care, especially for low-risk patients. |
| Databáze: | OpenAIRE |
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