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Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies.
Skolarus, Ted A; Hawley, Sarah T; Forman, Jane; Sales, Anne E; Sparks, Jordan B; Metreger, Tabitha; Burns, Jennifer; Caram, Megan V; Radhakrishnan, Archana; Dossett, Lesly A; Makarov, Danil V; Leppert, John T; Shelton, Jeremy B; Stensland, Kristian D; Dunsmore, Jennifer; Maclennan, Steven; Saini, Sameer; Hollenbeck, Brent K; Shahinian, Vahakn; Wittmann, Daniela A; Deolankar, Varad; Sriram, S.
Afiliación
  • Skolarus TA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. tskolarus@bsd.uchicago.edu.
  • Hawley ST; Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA. tskolarus@bsd.uchicago.edu.
  • Forman J; Department of Surgery, Urology Section, University of Chicago, Chicago, USA. tskolarus@bsd.uchicago.edu.
  • Sales AE; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Sparks JB; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
  • Metreger T; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Burns J; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Caram MV; Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA.
  • Radhakrishnan A; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Dossett LA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Makarov DV; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Leppert JT; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • Shelton JB; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
  • Stensland KD; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
  • Dunsmore J; Department of Surgery, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
  • Maclennan S; VA New York Harbor Healthcare System and NYU School of Medicine Departments of Urology and Population Health, New York, NY, USA.
  • Saini S; Surgical Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.
  • Hollenbeck BK; Department of Urology, Stanford University, Stanford, CA, USA.
  • Shahinian V; VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.
  • Wittmann DA; Department of Urology, University of California, Los Angeles, USA.
  • Deolankar V; Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA.
  • Sriram S; Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK.
Implement Sci Commun ; 5(1): 37, 2024 Apr 09.
Article en En | MEDLINE | ID: mdl-38594740
ABSTRACT

BACKGROUND:

Many men with prostate cancer will be exposed to androgen deprivation therapy (ADT). While evidence-based ADT use is common, ADT is also used in cases with no or limited evidence resulting in more harm than benefit, i.e., overuse. Since there are risks of ADT (e.g., diabetes, osteoporosis), it is important to understand the behaviors facilitating overuse to inform de-implementation strategies. For these reasons, we conducted a theory-informed survey study, including a discrete choice experiment (DCE), to better understand ADT overuse and provider preferences for mitigating overuse.

METHODS:

Our survey used the Action, Actor, Context, Target, Time (AACTT) framework, the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation-Behavior (COM-B) Model, and a DCE to elicit provider de-implementation strategy preferences. We surveyed the Society of Government Service Urologists listserv in December 2020. We stratified respondents based on the likelihood of stopping overuse as ADT monotherapy for localized prostate cancer ("yes"/"probably yes," "probably no"/"no"), and characterized corresponding Likert scale responses to seven COM-B statements. We used multivariable regression to identify associations between stopping ADT overuse and COM-B responses.

RESULTS:

Our survey was completed by 84 respondents (13% response rate), with 27% indicating "probably no"/"no" to stopping ADT overuse. We found differences across respondents who said they would and would not stop ADT overuse in demographics and COM-B statements. Our model identified 2 COM-B domains (Opportunity-Social, Motivation-Reflective) significantly associated with a lower likelihood of stopping ADT overuse. Our DCE demonstrated in-person communication, multidisciplinary review, and medical record documentation may be effective in reducing ADT overuse.

CONCLUSIONS:

Our study used a behavioral theory-informed survey, including a DCE, to identify behaviors and context underpinning ADT overuse. Specifying behaviors supporting and gathering provider preferences in addressing ADT overuse requires a stepwise, stakeholder-engaged approach to support evidence-based cancer care. From this work, we are pursuing targeted improvement strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03579680.
Palabras clave

Texto completo: 1 Base de datos: MEDLINE Idioma: En Revista: Implement Sci Commun Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Base de datos: MEDLINE Idioma: En Revista: Implement Sci Commun Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos