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JCO Oncol Pract. 2020 Mar 2:JOP1900576. doi: 10.1200/JOP.19.00576. [Epub ahead of print]

Patient Perspectives on the Implementation of Risk-Aligned Bladder Cancer Surveillance: Systematic Evaluation Using the Tailored Implementation for Chronic Diseases Framework.

Author information

1
White River Junction VA Medical Center, White River Junction, VT.
2
Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
3
Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH.
4
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH.
5
Department of Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH.
6
Salt Lake City VA Healthcare System, Salt Lake City, UT.
7
Department of Urology, University of Utah, Salt Lake City, UT.
8
New York Harbor VA Healthcare System, New York, NY.
9
Departments of Urology and Population Health, New York University, New York, NY.

Abstract

PURPOSE:

Many patients living with bladder cancer do not undergo surveillance that is aligned with their risk for recurrence or progression, which exposes them to unnecessary risk and burden of procedures. To implement risk-aligned surveillance as recommended by multiple guidelines, we need to understand patient-, provider-, and system-level factors contributing to the delivery of risk-aligned surveillance. In this study, we sought to systematically assess patient-level factors.

PARTICIPANTS AND METHODS:

Guided by the Tailored Implementation for Chronic Diseases framework, we conducted semistructured interviews with 22 patients with bladder cancer undergoing surveillance cystoscopy procedures at three facilities within the Department of Veterans Affairs. Patients were sampled using quantitative data on bladder cancer risk category (low v high) and on surveillance category (aligned v not aligned with cancer risk). Interview transcripts were analyzed using a priori codes from the Tailored Implementation for Chronic Diseases framework. Quantitative and qualitative data were integrated by cross-tabulating determinants across risk and surveillance categories.

RESULTS:

Participants included seven low-risk and 15 high-risk patients; 10 underwent risk-aligned surveillance and 12 did not. In mixed-methods analyses, perception of risk appropriately differed by risk but not by surveillance category. Participants understood the recommended surveillance schedule according to their risk category. Participants emphatically expressed that adhering to providers' recommendations is prudent; intentions to adhere did not vary across risk and surveillance categories.

CONCLUSION:

Participants intended to adhere to providers' recommendations and strongly endorsed the importance of adherence. These findings suggest implementation strategies to improve risk-aligned surveillance may be most effective when targeting provider- and system-level factors rather than patient-level factors.

PMID:
32119595
DOI:
10.1200/JOP.19.00576

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