Walker Melanie, Doiron R Christopher, French Simon D, Feldman-Stewart Deb, Siemens D Robert, Mackillop William J, Booth Christopher M
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.
Department of Oncology, Queen's University, Kingston, ON, Canada.
Can Urol Assoc J. 2018 Apr;12(4):E182-E190. doi: 10.5489/cuaj.4791. Epub 2017 Dec 22.
Use of chemotherapy for muscle-invasive bladder cancer (MIBC) is known to be low. To understand factors driving practice we use the Theoretical Domains Framework (TDF) to identify barriers and enablers of chemotherapy use.
A convenience sample of Canadian urologists, medical oncologists (MOs), and radiation oncologists (ROs) participated in individual, semi-structured, one-hour telephone interviews. An interview guide was developed using the TDF to assess potential barriers and enablers of chemotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation.
A total of 71 physicians were invited to participate and 34 (48%) agreed to be interviewed: 13 urologists, 10 MOs, and 11 ROs. We identified the following barriers to the use of chemotherapy (relevant TDF domains in parentheses): 1) belief that the benefits of chemotherapy are not clinically important (beliefs about consequences); 2) inadequate multidisciplinary collaboration (environmental context and resources); 3) absence of "champions" advocating the use of chemotherapy (social and professional role); and 4) a lack of organizational clarity/policy regarding the referral process (environmental context and resources). The predominant enablers identified included: 1) "champions" who believe in the value of chemotherapy (social and professional role); 2) urologists who refer all patients to MO (behavioural regulation; memory, attention, and decision-making); and 3) system-level factors, including automatic multidisciplinary referral (environmental context and resources).
We have identified several system-level factors associated with delivery of chemotherapy. Behaviour change interventions should optimize multidisciplinary care of patients with MIBC.
Despite the fact that chemotherapy before or after surgery improves survival of patients with bladder cancer, several studies have shown that many patients in routine practice are not treated. In this study, we identify important system-level and physician-level factors that must be considered in efforts to improve patient care.
已知肌肉浸润性膀胱癌（MIBC）的化疗使用率较低。为了解影响临床实践的因素，我们使用理论域框架（TDF）来确定化疗使用的障碍和促进因素。
选取加拿大泌尿外科医生、医学肿瘤学家（MO）和放射肿瘤学家组成便利样本，参与为期一小时的个人半结构化电话访谈。使用TDF制定访谈指南，以评估化疗使用的潜在障碍和促进因素。访谈进行录音和转录。两名研究人员独立确定障碍和促进因素，并将其归入特定主题。持续招募参与者直至饱和。
共邀请71名医生参与，34名（48%）同意接受访谈：13名泌尿外科医生、10名MO和11名放射肿瘤学家。我们确定了以下化疗使用障碍（括号内为相关TDF领域）：1）认为化疗的益处对临床不重要（对后果的信念）；2）多学科协作不足（环境背景和资源）；3）缺乏倡导化疗使用的“倡导者”（社会和职业角色）；4）关于转诊流程缺乏组织明确性/政策（环境背景和资源）。确定的主要促进因素包括：1）相信化疗价值的“倡导者”（社会和职业角色）；2）将所有患者转诊给MO的泌尿外科医生（行为调节；记忆、注意力和决策）；3）系统层面因素，包括自动多学科转诊（环境背景和资源）。
我们确定了与化疗实施相关的几个系统层面因素。行为改变干预应优化MIBC患者的多学科护理。
尽管手术前后化疗可提高膀胱癌患者的生存率，但多项研究表明，许多常规治疗中的患者未接受化疗。在本研究中，我们确定了在改善患者护理的努力中必须考虑的重要系统层面和医生层面因素。
