LeBlanc T W, Howson A, Turell W, Sheldon P, Locke S C, Tuchman S A, Gasparetto C, Kaura S, Khan Z M, Abernethy A P
Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and; Duke Cancer Institute, Duke University School of Medicine, Durham, NC, U.S.A.
Opus Science, Annapolis, MD, U.S.A.
Curr Oncol. 2016 Dec;23(6):e598-e604. doi: 10.3747/co.23.3298. Epub 2016 Dec 21.
Since the early 2000s, treatment options for multiple myeloma have rapidly expanded, adding significant complexity to the management of this disease. To our knowledge, no systematic qualitative research on clinical decision-making in multiple myeloma has been published. We sought to characterize how physicians view and implement guidelines and incorporate novel approaches into patient care.
We designed a semi-structured qualitative interview guide informed by literature review and an expert advisory panel. We conducted 60-minute interviews with a diverse sample of oncology physicians in the southeast United States. We used a constant comparative method to code and analyze interview transcripts. The research team and advisory panel discussed and validated emergent themes.
Participants were 13 oncologists representing 5 academic and 4 community practices. Academic physicians reported using formal risk-stratification schemas; community physicians typically did not. Physicians also described differences in eligibility criteria for transplantation; community physicians emphasized distance, social support, and psychosocial capacity in making decisions about transplantation referral; the academic physicians reported using more specific clinical criteria. All physicians reported using a maintenance strategy both for post-transplant and for transplant-ineligible patients; however, determining the timing of maintenance therapy initiation and the response were reported as challenging, as was recognition or definition of relapse, especially in terms of when treatment re-initiation is indicated.
Practices reported by both academic and community physicians suggest opportunities for interventions to improve patient care and outcomes through optimal multiple myeloma management and therapy selection. Community physicians in particular might benefit from targeted education interventions about risk stratification, transplant eligibility, and novel therapies.
自21世纪初以来，多发性骨髓瘤的治疗选择迅速增加，使得这种疾病的管理变得更加复杂。据我们所知，尚未发表关于多发性骨髓瘤临床决策的系统性定性研究。我们试图描述医生如何看待和实施指南，并将新方法纳入患者护理中。
我们根据文献综述和专家咨询小组设计了一份半结构化定性访谈指南。我们对美国东南部不同的肿瘤内科医生样本进行了60分钟的访谈。我们使用持续比较法对访谈记录进行编码和分析。研究团队和咨询小组讨论并验证了出现的主题。
参与者为13位肿瘤学家，代表5个学术机构和4个社区医疗机构。学术机构的医生报告使用正式的风险分层方案；社区医生通常不使用。医生们还描述了移植资格标准的差异；社区医生在决定移植转诊时强调距离、社会支持和心理社会能力；学术机构的医生报告使用更具体的临床标准。所有医生都报告在移植后和不符合移植条件的患者中使用维持治疗策略；然而，确定维持治疗开始的时机和反应被认为具有挑战性，复发的识别或定义也是如此，特别是在何时需要重新开始治疗方面。
学术机构和社区医生报告的做法表明，通过优化多发性骨髓瘤的管理和治疗选择，有机会进行干预以改善患者护理和治疗结果。特别是社区医生可能会从关于风险分层、移植资格和新疗法的针对性教育干预中受益。
