Med Decis Making - Decision to adopt medical technology: case study of breast cancer radiotherapy techniques.

Tópicos

{ use(2086) technolog(871) perceiv(783) }
{ decis(3086) make(1611) patient(1517) }
{ care(1570) inform(1187) nurs(1089) }
{ model(3480) simul(1196) paramet(876) }
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Resumo

JECTIVE: To understand decision making concerning adoption and nonadoption of accelerated partial breast radiotherapy (RT) prior to long-term randomized trial evidence.METHODS: A total of 36 radiation oncologists and surgeons were recruited through purposive and snowball sampling strategies from September 2010 through January 2013. Semistructured phone interviews were conducted and audio-recorded and lasted 20-45 minutes. Qualitative analysis was conducted using a framework approach, iteratively exploring key concepts and emerging issues raised by subjects. Interviews were transcribed and imported into Atlas.ti v6. Transcripts were independently coded by 3 researchers shortly after each interview, followed by consensus development on each coded transcript. Barriers and facilitators of adoption, practice patterns, and informational/educational sources concerning accelerated partial breast RT were all assessed to determine major themes.RESULTS: Nearly half of physicians were surgeons (47%), and half were radiation oncologists (53%), with 61% overall in urban settings. Twenty-nine of the 36 physicians interviewed used brachytherapy-based partial breast RT. Five major factors were involved in physicians' decisions to adopt accelerated partial breast RT: facilitators encouraging adoption (e.g., enthusiastic colleagues and patient convenience), financial and prestige incentives, pressures to adopt (e.g., potential declines in referrals), judgment concerning acceptable level of scientific evidence, and barriers (e.g., not having appropriate machinery or referral mechanism in place). If technology was adopted, clinical guideline adherence varied.CONCLUSIONS: Technology adoption is based on financial and social pressures, along with often-limited scientific evidence and what seems "best" for patients. For technology adoption and diffusion to be rational and evidence-based, we must encourage appropriate financial payment models to curb use outside of research studies and promote development of additional treatment registries until sufficient evidence is gathered.

Resumo Limpo

jectiv understand decis make concern adopt nonadopt acceler partial breast radiotherapi rt prior longterm random trial evidencemethod total radiat oncologist surgeon recruit purpos snowbal sampl strategi septemb januari semistructur phone interview conduct audiorecord last minut qualit analysi conduct use framework approach iter explor key concept emerg issu rais subject interview transcrib import atlasti v transcript independ code research short interview follow consensus develop code transcript barrier facilit adopt practic pattern informationaleduc sourc concern acceler partial breast rt assess determin major themesresult near half physician surgeon half radiat oncologist overal urban set twentynin physician interview use brachytherapybas partial breast rt five major factor involv physician decis adopt acceler partial breast rt facilit encourag adopt eg enthusiast colleagu patient conveni financi prestig incent pressur adopt eg potenti declin referr judgment concern accept level scientif evid barrier eg appropri machineri referr mechan place technolog adopt clinic guidelin adher variedconclus technolog adopt base financi social pressur along oftenlimit scientif evid seem best patient technolog adopt diffus ration evidencebas must encourag appropri financi payment model curb use outsid research studi promot develop addit treatment registri suffici evid gather

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