Impact of Social contagion on Physician use of unproven cancer interventions

社会传染对医生使用未经证实的癌症干预措施的影响

• 批准号: 9315785
• 负责人: Cary P. Gross
• 金额: $ 54.37万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-19 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9315785
• 关键词: Address; Adjuvant; Adopted; Adoption; Affect; Behavior; Breast; Cancer Intervention; Caring; Characteristics; Clinical; Communication; Complex; Diagnostic; Diagnostic radiologic examination; Diffuse; Diffusion; Diffusion of Innovation; Direct Costs; Evaluation; Fractionated radiotherapy; Goals; Guidelines; Health; Health system; Image; Individual; Internet; Intervention; Investigation; Light; Link; Magnetic Resonance Imaging; Malignant Neoplasms; Medical; Medicare; Metastatic Neoplasm to the Bone; Methods; Modeling; Nature; Outcome; Patient Care; Patients; Pattern; Patterns of Care; Physician' s Role; Physicians; Policies; Population; Positron-Emission Tomography; Property; Provider; Radiation; Radiation Oncologist; Radiation therapy; Role; Shapes; Social Concepts; Social Sciences; Structure; System; Technology; Testing; Therapeutic Radiology specialty; Time; Woman; Work; behavior change; behavior influence; beneficiary; cancer care; clinical care; clinical practice; contagion; cost; economic impact; individual patient; ineffective therapies; malignant breast neoplasm; new technology; novel; novel strategies; palliative; panacea; payment; peer; public health relevance; social; standard of care; technological innovation

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).

描述(由申请人提供)：使癌症治疗与最佳可用医学证据保持一致的努力主要集中在传播指南、加强医患沟通和修订支付方案上。尽管这些都是关键的策略，但对医生行为的另一个主要影响可能被忽视了--如果医生同行的做法是决定她或他是采用一种新的癌症干预措施还是放弃另一种干预措施的主要决定因素会怎么样？我们提出了一项关于医生和医生患者共享网络对采用和放弃癌症干预措施的影响的新调查。医生网络是一组医生，他们通过共享的患者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，从而使想法和行为在相互联系的人群中传播。现在是探索影响癌症护理提供的新概念的特别及时的时候，因为昂贵的、未经证实的、有时无效的癌症干预措施的迅速传播对癌症治疗系统的可持续性和个别患者的健康构成了重大威胁。例如，在过去的十年里，对患有乳腺癌的女性使用先进的成像测试(AIT)，如PET扫描和MRI，已经大幅增加，尽管几乎没有证据支持它们的使用。此外，一旦一种干预措施扩散到实践中并成为一种护理标准，即使有证据表明，与成本较低或负担较低的替代方案相比，它提供的增量效益有限或没有增量效益，它仍可以广泛使用。例如，放射肿瘤学家一直不愿放弃更长、更昂贵的乳腺癌“标准”放射疗程，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，我们将重点关注正在接受乳腺癌护理的联邦医疗保险受益人。我们的目标是(1)构建医生患者共享网络；(2)评估医生和社会传染对早期采用AITs以及早期放弃更昂贵和不方便的较长疗程放射治疗的影响；(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对人群水平的影响，包括成本、护理模式和结果。在任何复杂的系统中，理解驱动个人行为的因素都是至关重要的。对癌症护理中复杂的医患互动网络进行严格的分析，不仅可以丰富地了解医生如何影响同龄人的行为，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阻止使用未经证实的干预措施(挑衅性问题E-3)。

项目成果

Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI.

乳腺癌外科医生同伴网络特征和新成像技术的采用：围手术期 MRI 的研究。

• DOI: 10.1002/cam4.1821
• 发表时间: 2018-12
• 期刊: Cancer medicine
• 影响因子: 4
• 作者: Tannenbaum SS;Soulos PR;Herrin J;Pollack CE;Xu X;Christakis NA;Forman HP;Yu JB;Killelea BK;Wang SY;Gross CP
• 通讯作者: Gross CP

Physician trajectories of abandoning long-course breast radiotherapy and their cost impact.

医生放弃长期乳腺放疗的轨迹及其成本影响。

• DOI: 10.1111/1475-6773.13572
• 发表时间: 2021
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Xu,Xiao;Soulos,PamelaR;Herrin,Jeph;Wang,Shi-Yi;Pollack,CraigEvan;Evans,SuzanneB;Yu,JamesB;Gross,CaryP
• 通讯作者: Gross,CaryP

Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer.

同行对医生对乳腺癌患者使用短期外照射治疗的影响。

• DOI: 10.1016/j.prro.2019.11.001
• 发表时间: 2020
• 期刊: Practical radiation oncology
• 影响因子: 3.3
• 作者: Yu,JamesB;Pollack,CraigE;Herrin,Jeph;Soulos,PamelaR;Zhu,Weiwei;Xu,Xiao;Gross,CaryP
• 通讯作者: Gross,CaryP