Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists
Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists
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DOI：
10.1245/s10434-018-6863-1
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发表时间：
2019-02-01
影响因子：
3.7
通讯作者：
Meropol, Neal J.
中科院分区：
文献类型：
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作者：
Kim, Simon P.;Gross, Cary P.;Meropol, Neal J.
低风险前列腺癌(PCa)的主动监测(AS)临床采用率低的原因仍然知之甚少。因此，我们对放射肿瘤学家(ROS)和泌尿科医生(URO)进行了一项全国性调查，以阐明低风险PC对AS的感知障碍。2017年，我们对1855名ROS和URO进行了四波邮寄调查。该调查工具评估了对低风险PCA可能存在的障碍的态度。我们使用皮尔逊卡方和多变量Logistic回归分析来确定医生的特征与对ASS的态度有关。我们收到了691份完整的调查问卷，总体应答率为37.3%。大多数受访者表示，他们对推荐AS感到放心(90.0%)，同意高水平证据支持(82.3%)，并认为与手术和放射治疗一样有效的生存(84.4%)。与ROS相比，URO不太可能同意患者对低风险PCa不感兴趣(16.5vs.48.9%；调整后的优势比[OR]0.18，p<；0.001)。同样，与ROS相比，URO不太可能同意患者因重复前列腺活检而避免AS(36.3vs.55.4%；调整后OR0.41p<；0.001)。ROS和Uros更有可能同意患者更喜欢由受试者的专业提供的治疗。医生认为患者对AS缺乏兴趣，需要重复前列腺活检，以及患者治疗偏好偏向于他们自己的专业治疗，这是AS的关键障碍。共同决策可能是让患者参与治疗决定对话的一种有意义的方法。
The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa.In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS.We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent's specialty.Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.