A pilot study to increase adherence to ASCO Choosing Wisely recommendations for breast cancer surveillance at community clinics.

Abstract

18 Background: ASCO 2012 Choosing Wisely recommends against serum tumor marker tests and advanced imaging for breast cancer survivors who are asymptomatic for recurrence. Our pilot aimed to measure and raise adherence to this recommendation through a patient video at regional community clinics. Methods: Eligibility for study included patients with 1+ long-term follow-up visit within 3 months of end of treatment in the pre- or post-intervention period: Clinic tumor registries were queried for stage I-IIIA breast cancer patients treated with curative intent. The intervention included 1) academic detailing for oncologists at a regular meeting and 2) a video about the recommendation shown to patients at end of active treatment. Surveillance data was manually abstracted. We define adherence as no asymptomatic tests in the first 13 months of surveillance. Results: Advanced imaging adherence was high before and after the intervention (99-100%). Tumor marker (TM) adherence is in the table. Six of seven providers with low (<60%) TM adherence before the intervention maintained low TM adherence after. One provider with low TM adherence and all 3 providers with moderate (60-90%) TM adherence increased to high TM adherence (>90%). TM adherence was better among patients who viewed the video (130 of 145, 90%) than those who did not (452 of 556, 81%) in the post-intervention period. The higher TM adherence among patients who viewed the video and the wide range in adherence among providers suggest that tumor marker use may be both patient- and provider-driven. Population characteristics may explain some of the variation in adherence. Conclusions: While adherence to recommendations regarding high-cost imaging was high, wide variation in tumor marker adherence among providers and high baseline adherence for advanced imaging suggests that interventions targeting surveillance testing may wish to focus primarily on tumor markers and provider outreach. [Table: see text]

Characteristics and impact of interventions to support healthcare providers’ compliance with guideline recommendations for breast cancer: a systematic literature review

“…Eleven studies described interventions to support compliance with guidelines on diagnosis and treatment [ 41 , 43 , 52 , 56 , 64 – 70 ], 9 focused on treatment only [ 38 – 40 , 42 , 47 – 49 , 62 , 63 ], 5 on diagnosis only [ 45 , 51 , 58 – 60 ], and 7 on screening [ 36 , 37 , 46 , 50 , 54 , 57 , 61 ]. Six studies were randomized controlled trials [ 37 , 45 , 50 , 51 , 54 , 60 ], four were non-randomized controlled trials [ 46 , 57 , 58 , 63 ], eight non-controlled before-after studies [ 42 , 49 , 53 , 55 , 59 , 62 , 65 , 69 ], one prospective cohort study , three cross-sectional studies [ 44 , 47 , 56 ], one mixed-methods [ 36 ] and twelve case studies [ 38 – 41 , 43 , 48 , 52 , 61 , 64 , 66 – 68 ].…”

“…Six studies were randomized controlled trials [ 37 , 45 , 50 , 51 , 54 , 60 ], four were non-randomized controlled trials [ 46 , 57 , 58 , 63 ], eight non-controlled before-after studies [ 42 , 49 , 53 , 55 , 59 , 62 , 65 , 69 ], one prospective cohort study , three cross-sectional studies [ 44 , 47 , 56 ], one mixed-methods [ 36 ] and twelve case studies [ 38 – 41 , 43 , 48 , 52 , 61 , 64 , 66 – 68 ].…”

“…Table 2 describes the characteristics of each type of intervention. Twelve studies described two different interventions consisting in the implementation of computerized decision support systems [ 38 – 43 , 48 , 64 – 68 ], 7 described 6 different educational interventions targeting health care professionals [ 44 , 50 , 55 , 57 – 59 , 63 ], 9 described 9 multifaceted interventions [ 36 , 37 , 46 , 49 , 51 , 53 , 54 , 60 , 62 ], and two studies described two audit and feedback interventions [ 47 , 69 ]. The rest of the studies described interventions based on: implementation of clinical pathways [ 56 ], integrated knowledge translation systems [ 61 ], medical critiquing system [ 52 ], medical home program [ 70 ], and reminders to providers [ 45 ].…”

“… Master’s level nurse educator and standardized patient (trained to provide feedback to the physicians to enhance their clinical breast examination and communication skills). 1–2 h training session (tailored according to each physician's pre-intervention level of adherence to breast cancer screening guidelines and/or CME need) Kreizenbeck et al 2020 [ 55 ] Not reported Regional community oncology clinics in Washington (USA) Improve prescription in relation to the use of primary prophylactic colony stimulating factors for chemotherapy regimens with < 20% risk of febrile neutropenia Academic detailing for oncologists at a regular meeting Not reported 1 session McWhirter et al 2007 [ 59 ] Not reported Cancer center in Toronto (Canada) To reduce the number of unnecessary staging investigations performed Multidisciplinary educational rounds, highlighting the Cancer Care Ontario Practice Guidelines, and reporting results of the audit of staging investigations. Attendance at the rounds included staff and trainees in medical and radiation oncology, surgical oncology and pathology.…”

Navigating the High Costs of Cancer Care: Opportunities for Patient Engagement

“…In particular, the campaign provides education modules, which include five questions patients should ask providers before receiving any test, treatment or procedure, with the final question focused on the cost of treatment and the availability of less expensive alternatives. A recent study examining the use of serum tumor marker tests for breast cancer survivors who are asymptomatic found that when patients were given a Choosing Wisely educational module on the guidelines, the rates of adherence to the recommendations increased [59]. Other research indicates that such SDM approaches result in patients choosing less invasive -and less costly -treatments [60].…”