Benjamin R Roman1, Shivangi Lohia1, Nandita Mitra2, Marilene B Wang3, Anna M Pou4, F Christopher Holsinger5, David Myssiorek6, David Goldenberg7, David A Asch2, Judy A Shea2. 1. Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Head and Neck Surgery, University of California, Los Angeles, California. 4. Department of Otolaryngology, Ochsner Health System, Covington, Louisiana. 5. Department of Otolaryngology, Stanford University, Stanford, California. 6. Department of Surgery, Division of Otolaryngology Head and Neck Surgery, The Albert College of Medicine, Bronx, New York. 7. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Abstract
BACKGROUND: Why physicians use surveillance imaging for asymptomatic cancer survivors despite recommendations against this is not known. METHODS: Physicians surveilling head and neck cancer survivors were surveyed to determine relationships among attitudes, beliefs, guideline familiarity, and self-reported surveillance positron-emission-tomography/computed-tomography use. RESULTS: Among 459 responses, 79% reported using PET/CT on some asymptomatic patients; 39% reported using PET/CT on more than half of patients. Among attitudes/beliefs, perceived value of surveillance imaging (O.R. 3.57, C.I. 2.42-5.27, P = <.0001) was the strongest predictor of high imaging, including beliefs about outcome (improved survival) and psychological benefits (reassurance, better communication). Twenty-four percent of physicians were unfamiliar with guideline recommendations against routine surveillance imaging. Among physicians with high perceived-value scores, those less familiar with guidelines imaged more (O.R. 3.55, C.I. 1.08-11.67, P = .037). CONCLUSIONS: Interventions to decrease routine surveillance PET/CT use for asymptomatic patients must overcome physicians' misperceptions of its value. Education about guidelines may modify the effect of perceived value.
BACKGROUND: Why physicians use surveillance imaging for asymptomatic cancer survivors despite recommendations against this is not known. METHODS: Physicians surveilling head and neck cancer survivors were surveyed to determine relationships among attitudes, beliefs, guideline familiarity, and self-reported surveillance positron-emission-tomography/computed-tomography use. RESULTS: Among 459 responses, 79% reported using PET/CT on some asymptomatic patients; 39% reported using PET/CT on more than half of patients. Among attitudes/beliefs, perceived value of surveillance imaging (O.R. 3.57, C.I. 2.42-5.27, P = <.0001) was the strongest predictor of high imaging, including beliefs about outcome (improved survival) and psychological benefits (reassurance, better communication). Twenty-four percent of physicians were unfamiliar with guideline recommendations against routine surveillance imaging. Among physicians with high perceived-value scores, those less familiar with guidelines imaged more (O.R. 3.55, C.I. 1.08-11.67, P = .037). CONCLUSIONS: Interventions to decrease routine surveillance PET/CT use for asymptomatic patients must overcome physicians' misperceptions of its value. Education about guidelines may modify the effect of perceived value.
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