We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Implementation Strategies to Promote Short-Course Radiation for Bone Metastases.
- Authors
Gillespie, Erin F.; Santos, Patricia Mae G.; Curry, Michael; Salz, Talya; Chakraborty, Nirjhar; Caron, Michael; Fuchs, Hannah E.; Ledesma Vicioso, Nahomy; Mathis, Noah; Kumar, Rahul; O'Brien, Connor; Patel, Shivani; Guttmann, David M.; Ostroff, Jamie S.; Salner, Andrew L.; Panoff, Joseph E.; McIntosh, Alyson F.; Pfister, David G.; Vaynrub, Max; Yang, Jonathan T.
- Abstract
Key Points: Question: Is a multicomponent set of implementation strategies (guidelines, electronic consultations [eConsults], and audit-and-feedback reports) associated with improved uptake of short-course radiation within an academic-community partnership? Findings: In this quality improvement study conducted across 3 community-based cancer centers, a multicomponent set of strategies was not associated with increased use of short-course radiation for nonspine bone metastases. However, short-course radiation practice significantly improved with time, perhaps owing to secular trends or physician awareness of the study. Meaning: These findings demonstrate a need to examine approaches for encouraging uptake of short-course radiation and other evidence-based practices to improve care among patients with nonspine bone metastases. This quality improvement study examines whether 3 implementation strategies (guidelines, electronic consultations, and audit-and-feedback reports) are associated with increased adoption of a consensus recommendation to treat patients with nonspine bone metastases with short-course radiotherapy. 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.
- Subjects
CONSENSUS (Social sciences); MEDICAL protocols; COMMUNITY health services; CANCER treatment; AUDITING; RADIOTHERAPY; RESEARCH funding; STATISTICAL sampling; LOGISTIC regression analysis; FISHER exact test; TREATMENT effectiveness; RANDOMIZED controlled trials; DESCRIPTIVE statistics; BONE metastasis; LONGITUDINAL method; PUBLIC relations; TELEMEDICINE; MEDICAL consultation; ODDS ratio; COMMUNICATION; RADIATION doses; QUALITY assurance; CONFIDENCE intervals; EVIDENCE-based medicine; DATA analysis software; SPECIALTY hospitals; EVALUATION
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2411717
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.11717