Department of Urology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
BJU Int. 2018 May;121 Suppl 3:22-27. doi: 10.1111/bju.14144. Epub 2018 Feb 16.
To improve imaging utilisation and reduce the widespread overuse of staging investigations, in the form of computed tomography (CT) and whole-body bone scans for men with newly diagnosed prostate cancer in the Hunter region of NSW, Australia, by implementation of a multifaceted clinician-centred behaviour change programme.
Records of all patients with a new diagnosis of prostate cancer were reviewed prior to the intervention (July 2014 to July 2015), and the results of this audit were presented to participating urologists by a clinical champion. Urologists then underwent focused education based on current guidelines. Patterns of imaging use for staging were then re-evaluated (November 2015 to July 2016). Patients were stratified into low-, intermediate- and high-risk groups as described by the D'Amico classification system.
A total of 144 patients were retrospectively enrolled into the study cohort. The use of diagnostic imaging for staging purposes significantly decreased in men with low- and intermediate-risk disease post intervention. In low-risk patients, the use of CT decreased from 43% to 0% (P = 0.01). A total of 21% of patients underwent bone scans in the pre-intervention group compared with18% in the post-intervention group (P = 0.84). In intermediate-risk patients, the use of CT decreased from 89% to 34% (P < 0.001), whilst the use of bone scan decreased from 63% to 37% (P = 0.02). In high-risk patients, the appropriate use of imaging was maintained, with CT performed in 87% compared with 85% and bone scan in 87% compared with 65% (P = 0.07).
Our results show that a focused, clinician-centred education programme can lead to improved guideline adherence at a regional level. The assessment of trends and application of such a programme at a state-based or national level could be further assessed in the future with the help of registry data. This will be particularly important in future with the advent of advanced imaging, such as prostate-specific membrane antigen positron-emission tomography.
通过实施多方面以临床医生为中心的行为改变计划，提高澳大利亚新南威尔士州亨特地区新诊断为前列腺癌男性的影像学利用率，减少广泛存在的过度使用分期检查（即计算机断层扫描（CT）和全身骨扫描）的现象。
在干预前（2014 年 7 月至 2015 年 7 月）回顾所有新诊断为前列腺癌患者的记录，并由临床冠军向参与的泌尿科医生展示该审计结果。然后，泌尿科医生接受基于当前指南的集中教育。然后重新评估分期成像的使用模式（2015 年 11 月至 2016 年 7 月）。患者按 D'Amico 分类系统分为低危、中危和高危组。
共有 144 名患者被回顾性纳入研究队列。在干预后，低危和中危疾病男性的诊断性影像学分期检查使用率显著降低。在低危患者中，CT 的使用率从 43%降至 0%（P=0.01）。在干预前组中，有 21%的患者接受了骨扫描，而在干预后组中，这一比例为 18%（P=0.84）。在中危患者中，CT 的使用率从 89%降至 34%（P<0.001），而骨扫描的使用率从 63%降至 37%（P=0.02）。在高危患者中，维持了适当的影像学使用，CT 使用率为 87%，与 85%相比，骨扫描使用率为 87%，与 65%相比（P=0.07）。
我们的结果表明，集中、以临床医生为中心的教育计划可以提高区域层面的指南遵循率。在未来，可以借助登记数据进一步评估在州级或国家级评估和应用这种计划的趋势。这在未来具有重要意义，因为先进的影像学技术（如前列腺特异性膜抗原正电子发射断层扫描）的出现。
