Saeed Nadia A, Blakaj Adriana, Kelly Jacqueline R, Decker Roy H, Ford Eric C, Brown Derek W, Dosoretz Arie P, Evans Suzanne B
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Hartford Radiation Oncology Associates, Hartford, Connecticut.
Adv Radiat Oncol. 2022 Jul 22;7(6):101033. doi: 10.1016/j.adro.2022.101033. eCollection 2022 Nov-Dec.
The Federal Aviation Administration quantifies hazardous attitudes (HAs) among pilots using a scale. HAs have been linked to aviation risk. We assessed the influence of HAs and other factors in treatment decision making in radiation oncology (RO).
An anonymous survey was sent to 809 radiation oncologists in US cities housing the top 25 cancer centers. The survey included an HA scale adapted for RO and presented 9 cases assessing risk-tolerant radiation therapy prescribing habits and compliance with the American Society for Radiation Oncology's recommendations. Demographic and treatment decision data were dichotomized to identify factors associated with prescribing habits using univariable and multivariable (MVA) logistic regression analyses.
A total of 139 responses (17.1%) were received, and 103 were eligible for analysis. Among respondents, 40% were female, ages were evenly distributed, and 83% were in academics. Median scores for all attitudes (macho, anti-authority, worry, resignation, and impulsivity) were below the aviation thresholds for hazard and data from surgical specialties. On MVA, responders >50 years old with >5 years' experience were 4.45 times more likely to recommend risk-tolerant radiation ( = .016). Macho attitude was negatively associated with compliant treatments (odds ratio [OR], 0.12; = .001). Physicians who reported having previously retreated the supraclavicular fossa without complication were more likely to recommend retreatment in medically unfit patients if they felt the complication was avoided owing to careful planning (OR, 5.2; = .008).
To our knowledge, this represents the first study analyzing physician attitudes in RO and their effect on self-reported treatment decisions. This work suggests that attitude may be among the factors that influence risk-tolerant prescribing practices and compliance with recommendations.
美国联邦航空管理局使用一种量表对飞行员中的危险态度（HAs）进行量化。危险态度与航空风险相关。我们评估了危险态度及其他因素在放射肿瘤学（RO）治疗决策中的影响。
向美国25家顶级癌症中心所在城市的809名放射肿瘤学家发送了一份匿名调查问卷。该问卷包括一个适用于放射肿瘤学的危险态度量表，并呈现了9个病例，以评估风险容忍型放射治疗的处方习惯以及是否符合美国放射肿瘤学会的建议。将人口统计学和治疗决策数据进行二分法处理，以使用单变量和多变量（MVA）逻辑回归分析来确定与处方习惯相关的因素。
共收到139份回复（17.1%），其中103份符合分析条件。在受访者中，40%为女性，年龄分布均匀，83%从事学术工作。所有态度（男子气概、反权威、担忧、顺从和冲动）的中位数得分均低于航空领域的危险阈值以及外科专业的数据。在多变量分析中，年龄超过50岁且有超过5年经验的受访者推荐风险容忍型放射治疗的可能性高出4.45倍（P = 0.016）。男子气概态度与合规治疗呈负相关（比值比[OR]，0.12；P = 0.001）。报告曾对锁骨上窝进行再次治疗且无并发症的医生，如果他们认为由于精心规划而避免了并发症，那么在医学上不适合的患者中更有可能推荐再次治疗（OR，5.2；P = 0.008）。
据我们所知，这是第一项分析放射肿瘤学中医生态度及其对自我报告的治疗决策影响的研究。这项工作表明，态度可能是影响风险容忍型处方实践和遵循建议的因素之一。
