Lena Schreiber1, Ryan Zeh1, Christina Monsour1, Aslam Ejaz1, Allan Tsung1, Timothy M Pawlik1, Eric Miller2, Anne Noonan2, Somashekar G Krishna3, Heena Santry1, Jordan M Cloyd4. 1. Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA. 2. Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA. 3. Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA. 4. Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA. Electronic address: jordan.cloyd@osumc.edu.
Abstract
BACKGROUND: Neoadjuvant therapy (NT) is increasingly utilized for patients with localized pancreatic ductal adenocarcinoma (PDAC). Given the importance of completing multimodality therapy, the purpose of this qualitative study was to characterize physician perspectives on barriers and facilitators to delivering NT. METHODS: A purposive sample of surgical, medical, and radiation oncologists participated in semi-structured interviews. Interviews were transcribed and coded by 3 independent researchers, iteratively identifying themes until saturation was achieved. RESULTS: Participants (n = 27) were heterogeneous in specialty, years of experience, practice setting, gender, and geography. The most commonly cited advantage of NT was the ability to downstage patients. The most commonly cited barriers included lack of access and limited evidence. Patient preference for immediate surgery was frequently cited as a barrier, but most participants felt that patients eventually understood the treatment recommendation after informed discussion. Recommendations to enhance the delivery of NT included improved patient education, communication, and better evidence. CONCLUSION: In this qualitative study, indications for, barriers to, and opportunities to improve the delivery of NT for localized PDAC were identified. These results highlight the need for better evidence and protocol standardization for NT as well as methods of improving care coordination, communication, and education to improve patient-centered outcomes.
BACKGROUND: Neoadjuvant therapy (NT) is increasingly utilized for patients with localized pancreatic ductal adenocarcinoma (PDAC). Given the importance of completing multimodality therapy, the purpose of this qualitative study was to characterize physician perspectives on barriers and facilitators to delivering NT. METHODS: A purposive sample of surgical, medical, and radiation oncologists participated in semi-structured interviews. Interviews were transcribed and coded by 3 independent researchers, iteratively identifying themes until saturation was achieved. RESULTS: Participants (n = 27) were heterogeneous in specialty, years of experience, practice setting, gender, and geography. The most commonly cited advantage of NT was the ability to downstage patients. The most commonly cited barriers included lack of access and limited evidence. Patient preference for immediate surgery was frequently cited as a barrier, but most participants felt that patients eventually understood the treatment recommendation after informed discussion. Recommendations to enhance the delivery of NT included improved patient education, communication, and better evidence. CONCLUSION: In this qualitative study, indications for, barriers to, and opportunities to improve the delivery of NT for localized PDAC were identified. These results highlight the need for better evidence and protocol standardization for NT as well as methods of improving care coordination, communication, and education to improve patient-centered outcomes.
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Authors: Jordan M Cloyd; Victor Heh; Timothy M Pawlik; Aslam Ejaz; Mary Dillhoff; Allan Tsung; Terence Williams; Laith Abushahin; John F P Bridges; Heena Santry Journal: J Clin Med Date: 2020-04-15 Impact factor: 4.241
Authors: Syed A Ahmad; Mai Duong; Davendra P S Sohal; Namita S Gandhi; Muhammad Shaalan Beg; Andrea Wang-Gillam; James L Wade; Elena Gabriela Chiorean; Katherine A Guthrie; Andrew M Lowy; Philip A Philip; Howard S Hochster Journal: Ann Surg Date: 2020-09-01 Impact factor: 13.787