Impact of Social contagion on Physician use of unproven cancer interventions

描述（由申请人提供）：将癌症治疗与现有的最佳医学证据结合起来的努力主要集中在传播指导方针、加强医患沟通和修改支付方案上。尽管这些都是至关重要的策略，但对医生行为的另一个主要影响可能被忽视了——如果医生同行的实践是她或他是否采用一种新的癌症干预措施或放弃另一种干预措施的主要决定因素呢？我们提出了一项新的调查，医生和医生-患者共享网络对癌症干预措施的采用和放弃的影响。医生网络是一群医生，他们通过共享的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的方式在这样的网络中传播，从而使思想和行为在相互联系的人群中传播。随着昂贵的、未经证实的、有时无效的癌症干预措施的迅速扩散，对癌症治疗系统的可持续性和个体患者的健康构成了重大威胁，探索塑造癌症治疗交付的新结构尤为及时。例如，在过去十年中，对患有乳腺癌的妇女使用PET扫描和MRI等高级成像测试（ait）的人数大幅增加，尽管几乎没有证据支持它们的使用。此外，一旦一种干预措施在实践中扩散并成为一种标准护理，即使有证据表明，与更便宜或负担更少的替代方案相比，它提供的增量效益有限或没有，也可以继续广泛使用。例如，放射肿瘤学家一直不愿意放弃治疗乳腺癌的更长、更昂贵的“标准”放射疗程，尽管有证据表明，较短的疗程也能产生类似的结果。为了解决这些问题，我们将重点关注接受乳腺癌治疗的医疗保险受益人。我们的目标是(1)构建医患共享网络；(2)评估医生和社会传染对早期采用人工智能和早期放弃更昂贵和不方便的长疗程放疗的影响；(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；(4)评估医生在成本、护理模式和结果方面采用和放弃这些干预措施对人口水平的影响。在任何复杂的系统中，理解驱动个体行为的因素是至关重要的。对癌症治疗中医生和病人相互作用的复杂网络进行严格的分析，不仅可以对医生如何影响其同伴的行为提供丰富的理解，而且还可以确定一个潜在的强大杠杆，以诱导医生放弃无效的干预措施或劝阻使用未经证实的干预措施（挑衅问题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).