Impact of Social contagion on Physician use of unproven cancer interventions

描述（由申请人提供）：将癌症护理与最佳医学证据相结合的努力主要集中在传播指南，加强医患沟通和修改支付方案上。虽然这些都是关键的策略，但可能对医生行为的另一个主要影响被忽视了-如果医生的同行的做法是她或他是否采用一种新的癌症干预或放弃另一种的主要决定因素呢？我们提出了一个新的调查医生和医生病人共享网络的影响，采用和放弃癌症干预措施。医生网络是一群医生，他们通过共享病人直接或间接地相互合作。新的癌症管理方法可以通过社会传染通过这样的网络传播，思想和行为通过相互联系的人群传播。 探索塑造癌症护理交付的新结构是特别及时的，因为昂贵的，未经证实的，有时无效的癌症干预措施的快速扩散对癌症护理系统的可持续性和个体患者的健康构成了重大威胁。例如，在过去的十年中，先进的成像测试（AIT），如PET扫描和MRI，在乳腺癌患者中的使用大幅增加，尽管几乎没有证据支持它们的使用。此外，一旦干预措施扩散到实践中并成为护理标准，即使有证据表明与较便宜或负担较重的替代品相比，它提供的益处有限或没有增量，它也可以继续广泛使用。例如，放射肿瘤学家一直不愿意放弃乳腺癌放射治疗的更快和更昂贵的“标准”疗程，尽管有证据表明较短的疗程会产生类似的结果。 为了解决这些问题，我们将重点关注接受乳腺癌护理的医疗保险受益人。我们的目标是（1）构建医生和患者共享网络;（2）评估医生和社会传染对早期采用AIT和早期放弃更昂贵和更不方便的长期放疗的影响;（3）确定与早期采用或放弃干预措施相关的医生和医生网络特征;以及（4）评估医生采用和放弃这些干预措施在成本、护理模式和结果方面对医生的人群水平影响。在任何复杂的系统中，了解驱动个体行为的因素至关重要。对癌症护理中医生和患者互动的复杂网络进行严格分析，不仅可以丰富地了解医生如何影响同行的行为，而且还可以确定一个潜在的强大杠杆，用于诱导医生放弃无效的干预措施或阻止使用未经证实的干预措施（挑衅性问题E-3）。

DESCRIPTION (provided by applicant): Efforts to align cancer care with the best available medical evidence have largely focused on disseminating guidelines, enhancing physician-patient communication, and revising payment schema. Although these are critical strategies, it is possible that another major influence on physician behavior has been overlooked - what if the practice of a physician's peers was a major determinant of whether she or he adopts one new cancer intervention or abandons another? We propose a novel investigation of the impact of physicians and physician patient-sharing networks on the adoption and abandonment of cancer interventions. Physician networks are groups of physicians who work with one another either directly or indirectly, through shared patients. New cancer management approaches could diffuse through such networks via social contagion, whereby ideas and behaviors spread through interconnected groups of people. It is particularly timely to explore new constructs that shape the delivery of cancer care, as the rapid diffusion of expensive, unproven, and sometimes ineffective cancer interventions poses a significant threat to the sustainability of the cancer car system and to the health of individual patients. For instance, the use of advanced imaging tests (AITs) such as PET scans and MRI for women with breast cancer has increased substantially over the past decade, despite little evidence supporting their use. Further, once an intervention has diffused into practice and become a standard of care, it can remain widely used even when there is evidence that it provides limited or no incremental benefit compared to less expensive or burdensome alternatives. For example, radiation oncologists have been reluctant to abandon the lengthier and more expensive "standard" courses of radiation for breast cancer, despite evidence that shorter courses yield similar outcomes. To address these concerns, we will focus on Medicare beneficiaries undergoing breast cancer care. We aim to (1) construct physician patient-sharing networks; (2) assess the impact of physicians and social contagion on the early adoption of AITs and the early abandonment of more costly and inconvenient longer-course radiotherapy; (3) identify physician and physician network characteristics associated with early adoption or abandonment of interventions; and (4) assess the population-level impact of physicians' adoption and abandonment of these interventions in terms of costs, care patterns, and outcomes, across physicians. Within any complex system, it is critical to understand factors that drive the behavior of individuals. A rigorous analysis of the complex web of physician and patient interactions in cancer care can not only provide a rich understanding of how physicians influence the behavior of their peers, but also identify a potentially powerful lever for inducing physicians to abandon ineffective interventions or discourage the use of unproven ones (Provocative Question E-3).