Janet E Squires1, Sarah Asad2, Melissa Demery Varin3, Kristin Dorrance4, Edward Chow5, Alysa Fairchild6, Rebecca Wong7, Ian D Graham8, Jeremy M Grimshaw9, Kristopher Dennis10. 1. School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. School of Nursing, University of Ottawa, Ottawa, Ontario, Canada. 4. Statistics Canada, Ottawa, Ontario, Canada. 5. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 6. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada. 7. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 8. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. 9. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 10. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada. Electronic address: krdennis@toh.ca.
Abstract
BACKGROUND: A mainstay therapy for pain relief from uncomplicated bone metastases is external beam radiation therapy. Single fraction radiation therapy (SFRT) is more convenient and cost-effective, causes fewer acute side effects, and is equivalent to multiple fraction radiation therapy for pain relief. Despite these advantages, radiation oncologists seldom prescribe SFRT. PURPOSE: To identify the behavioral determinants to Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases. METHODS AND MATERIALS: Semistructured interviews were conducted with 38 radiation oncologists from all 10 Canadian provinces. The interview guide and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were analyzed using a 5-phase thematic content analysis process: coding, generation of belief statements, generation of themes within TDF domains, generation of overarching themes, and classification of themes as barriers or facilitators to SFRT use, or as divergent (a barrier or facilitator depending on the participant). RESULTS: Thirteen overarching themes were identified of which 2 were barriers, 7 were facilitators, and 4 were divergent. The most commonly identified theme was the facilitator "most radiation oncologists are aware of evidence and guidelines on the use SFRT" (n = 38, 100%). The 3 next most reported themes (n = 37, 97.4% ) were (1) "radiation oncologists' use of SFRT can influence their colleagues" use of it (divergent), (2) experience with SFRT can increase its use (facilitator), and (3) SFRT is convenient for patients (facilitator). The most commonly identified barrier (n = 31, 81.6%) was "SFRT is associated with a higher risk of retreatment." CONCLUSIONS: Our use of the TDF to explore the behavioral determinants of Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases identified a range of factors that are perceived to encourage and discourage its use. Our results will inform the design of future interventions to increase the use of SFRT.
BACKGROUND: A mainstay therapy for pain relief from uncomplicated bone metastases is external beam radiation therapy. Single fraction radiation therapy (SFRT) is more convenient and cost-effective, causes fewer acute side effects, and is equivalent to multiple fraction radiation therapy for pain relief. Despite these advantages, radiation oncologists seldom prescribe SFRT. PURPOSE: To identify the behavioral determinants to Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases. METHODS AND MATERIALS: Semistructured interviews were conducted with 38 radiation oncologists from all 10 Canadian provinces. The interview guide and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were analyzed using a 5-phase thematic content analysis process: coding, generation of belief statements, generation of themes within TDF domains, generation of overarching themes, and classification of themes as barriers or facilitators to SFRT use, or as divergent (a barrier or facilitator depending on the participant). RESULTS: Thirteen overarching themes were identified of which 2 were barriers, 7 were facilitators, and 4 were divergent. The most commonly identified theme was the facilitator "most radiation oncologists are aware of evidence and guidelines on the use SFRT" (n = 38, 100%). The 3 next most reported themes (n = 37, 97.4% ) were (1) "radiation oncologists' use of SFRT can influence their colleagues" use of it (divergent), (2) experience with SFRT can increase its use (facilitator), and (3) SFRT is convenient for patients (facilitator). The most commonly identified barrier (n = 31, 81.6%) was "SFRT is associated with a higher risk of retreatment." CONCLUSIONS: Our use of the TDF to explore the behavioral determinants of Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases identified a range of factors that are perceived to encourage and discourage its use. Our results will inform the design of future interventions to increase the use of SFRT.
Authors: Patricia Mae G Santos; Noah J Mathis; Kaitlyn Lapen; Stephanie Lobaugh; Divya Yerramilli; Justin E Bekelman; Erin F Gillespie Journal: JAMA Health Forum Date: 2022-01-14
Authors: Erin F Gillespie; Noah J Mathis; Max Vaynrub; Ernesto Santos Martin; Rupesh Kotecha; Joseph Panoff; Andrew L Salner; Alyson F McIntosh; Ranju Gupta; Amitabh Gulati; Divya Yerramilli; Amy J Xu; Meredith Bartelstein; David M Guttmann; Yoshiya J Yamada; Diana Lin; Kaitlyn Lapen; Deborah Korenstein; David G Pfister; Allison Lipitz-Snyderman; Jonathan T Yang Journal: Clin Transl Radiat Oncol Date: 2022-04-26