دورية أكاديمية
أعرض في EDS

Implementation Strategies to Promote Short-Course Radiation for Bone Metastases.

التفاصيل البيبلوغرافية
العنوان: Implementation Strategies to Promote Short-Course Radiation for Bone Metastases.
المؤلفون: Gillespie EF; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.; Department of Radiation Oncology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle., Santos PMG; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Curry M; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Salz T; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Chakraborty N; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Caron M; Department of Strategic Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York., Fuchs HE; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Ledesma Vicioso N; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Mathis N; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Kumar R; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami., O'Brien C; Department of Radiation Oncology, Hartford HealthCare Cancer Institute, Hartford, Connecticut., Patel S; Department of Radiation Oncology, Lehigh Valley Cancer Institute, Allentown, Pennsylvania., Guttmann DM; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Ostroff JS; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York., Salner AL; Department of Radiation Oncology, Hartford HealthCare Cancer Institute, Hartford, Connecticut., Panoff JE; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami., McIntosh AF; Department of Radiation Oncology, Lehigh Valley Cancer Institute, Allentown, Pennsylvania., Pfister DG; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Vaynrub M; Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York., Yang JT; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.; Department of Radiation Oncology, NYU School of Medicine, New York, New York., Lipitz-Snyderman A; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
المصدر: JAMA network open [JAMA Netw Open] 2024 May 01; Vol. 7 (5), pp. e2411717. Date of Electronic Publication: 2024 May 01.
نوع المنشور: Journal Article; Randomized Controlled Trial
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Bone Neoplasms*/secondary , Bone Neoplasms*/radiotherapy , Quality Improvement*, Humans ; Female ; Male ; Middle Aged ; Prospective Studies ; Aged ; Guideline Adherence/statistics & numerical data ; Practice Patterns, Physicians'/statistics & numerical data
مستخلص: Importance: For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings.
Objective: To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions).
Design, Setting, and Participants: This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023.
Exposures: Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians.
Main Outcomes and Measures: The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy.
Results: Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly.
Conclusions and Relevance: In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.
References: JAMA. 2022 Sep 6;328(9):850-860. (PMID: 36066518)
J Natl Cancer Inst. 2005 Jun 1;97(11):798-804. (PMID: 15928300)
Clin Trials. 2015 Oct;12(5):457-66. (PMID: 26374685)
JAMA Surg. 2019 Jun 1;154(6):510-515. (PMID: 30865220)
Pract Radiat Oncol. 2020 Mar - Apr;10(2):75-83. (PMID: 31785370)
Implement Sci. 2017 Aug 29;12(1):108. (PMID: 28851459)
Implement Sci. 2015 Aug 07;10:109. (PMID: 26249843)
Implement Sci Commun. 2021 Feb 13;2(1):19. (PMID: 33581728)
JAMA. 2014 Jul 2;312(1):29-30. (PMID: 25058212)
Pract Radiat Oncol. 2015 Nov-Dec;5(6):398-405. (PMID: 26432676)
Int J Radiat Oncol Biol Phys. 2021 Feb 1;109(2):374-386. (PMID: 32966890)
J Community Psychol. 2018 Sep;46(7):941-952. (PMID: 30565736)
Lancet Oncol. 2021 Jul;22(7):1023-1033. (PMID: 34126044)
JAMA. 2013 Oct 9;310(14):1501-2. (PMID: 24104375)
J Clin Oncol. 2019 Jan 10;37(2):93-96. (PMID: 30407894)
Radiother Oncol. 1999 Aug;52(2):111-21. (PMID: 10577696)
Qual Saf Health Care. 2008 Aug;17(4):296-300. (PMID: 18678729)
JCO Oncol Pract. 2021 Dec;17(12):e786-e792. (PMID: 34665674)
Pract Radiat Oncol. 2014 Nov-Dec;4(6):349-55. (PMID: 25407853)
JAMA Health Forum. 2022 Jan 14;3(1):e214468. (PMID: 35977234)
JCO Oncol Pract. 2022 May;18(5):e780-e785. (PMID: 35544650)
Implement Sci. 2022 Oct 29;17(1):75. (PMID: 36309746)
Int J Radiat Oncol Biol Phys. 2004 Jun 1;59(2):528-37. (PMID: 15145173)
J Healthc Manag. 2014 May-Jun;59(3):177-93. (PMID: 24988672)
Implement Sci. 2009 Aug 07;4:50. (PMID: 19664226)
JCO Oncol Pract. 2023 Feb;19(2):e197-e212. (PMID: 36399692)
JAMA Oncol. 2019 Jun 1;5(6):872-878. (PMID: 31021390)
Clin Transl Radiat Oncol. 2022 Apr 26;35:76-83. (PMID: 35620018)
Pract Radiat Oncol. 2017 Jan - Feb;7(1):4-12. (PMID: 27663933)
J Natl Compr Canc Netw. 2019 Sep 1;17(9):1083-1087. (PMID: 31487684)
Lancet. 2019 May 18;393(10185):2051-2058. (PMID: 30982687)
Radiother Oncol. 2019 Dec;141:56-61. (PMID: 31445837)
Lancet Oncol. 2016 Dec;17(12):1672-1682. (PMID: 27789196)
Adm Policy Ment Health. 2011 Mar;38(2):65-76. (PMID: 20957426)
Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):923-931. (PMID: 33188862)
Radiother Oncol. 2005 Apr;75(1):54-63. (PMID: 15878101)
Implement Sci. 2015 Feb 12;10:21. (PMID: 25889199)
BMJ Qual Saf. 2022 Oct;31(10):754-767. (PMID: 35750494)
Lancet. 1993 Nov 27;342(8883):1317-22. (PMID: 7901634)
Implement Sci. 2020 Jun 3;15(1):41. (PMID: 32493348)
Am J Med Qual. 2019 Jul/Aug;34(4):409-411. (PMID: 30654620)
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259. (PMID: 22696318)
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2):251-258. (PMID: 27473817)
J Clin Oncol. 2019 Jun 20;37(18):1558-1565. (PMID: 31067138)
J Clin Oncol. 2020 Sep 1;38(25):2830-2838. (PMID: 32484754)
معلومات مُعتمدة: P30 CA008748 United States CA NCI NIH HHS
تواريخ الأحداث: Date Created: 20240524 Date Completed: 20240524 Latest Revision: 20240716
رمز التحديث: 20240717
مُعرف محوري في PubMed: PMC11127116
DOI: 10.1001/jamanetworkopen.2024.11717
PMID: 38787561
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2024.11717