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01-03-2018 | Original Research

Assessment of contouring resource use and awareness of contouring guidelines among radiation oncologists

Published in: Journal of Radiation Oncology | Issue 1/2018

Abstract

Objective

Clinical questions arise frequently at the point of care, and approximately half of these questions go unanswered, representing an opportunity to improve quality of care. Radiation oncologists perform the unique task of contour delineation, which has been linked to decreased survival and increased toxicity when performed inaccurately. Little is known about how radiation oncologists approach contouring-related questions in clinical practice.

Methods

A survey was distributed to all attendees of an educational contouring symposium at the 2017 Annual Meeting of the American College of Radiation Oncology. Providers indicated their years of clinical experience and level of specialization and answered questions regarding resources used to answer contouring-related questions, awareness of consensus contouring guidelines, and barriers to guideline usage.

Results

Eighty-three out of 85 radiation oncologists attending the symposium returned the survey (97.6%). The majority of respondents were generalists (85%) and had over 10 years of clinical experience (73%). The most frequently used contouring resource was Radiation Therapy Oncology Group atlases (mean Likert score 4.1). Participants correctly identified the existence of consensus contouring guideline publications 42% of the time. The main barriers to guideline usage were a lack of awareness regarding publication (60%), poor ease of use (30%), lack of time (23%), and lack of comprehensiveness of available resources (21%).

Conclusion

This study provides information to guide further development and implementation of contouring resources, with radiation oncologists preferring resources that are atlas-based and can be accessed quickly and easily. Both self-reported and objectively tested awareness of consensus contouring guidelines was low, reflecting a need for better guideline dissemination.

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Segedin B, Petric P (2016) Uncertainties in target volume delineation in radiotherapy—are they relevant and what can we do about them? Radiol Oncol 50(3):254–262. https://doi.org/10.1515/raon-2016-0023 CrossRefPubMedPubMedCentral

Berry SL, Boczkowski A, Ma R, Mechalakos J, Hunt M (2016) Interobserver variability in radiation therapy plan output: results of a single-institution study. Pract Radiat Oncol 6(6):442–449. https://doi.org/10.1016/j.prro.2016.04.005 CrossRefPubMedPubMedCentral

Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D (2010) Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol 28(18):2996–3001. https://doi.org/10.1200/JCO.2009.27.4498 CrossRefPubMed

Ohri N, Shen X, Dicker AP, Doyle LA, Harrison AS, Showalter TN (2013) Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst 105(6):387–393. https://doi.org/10.1093/jnci/djt001 CrossRefPubMedPubMedCentral

Boero IJ, Paravati AJ, Xu B, Cohen EEW, Mell LK, Le QT, Murphy JD (2016) Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy. J Clin Oncol 34(7):684–690. https://doi.org/10.1200/JCO.2015.63.9898 CrossRefPubMedPubMedCentral

Del Fiol G, Workman TE, Gorman PN (2014) Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med 174(5):710–718. https://doi.org/10.1001/jamainternmed.2014.368 CrossRefPubMed

Ellsworth MA, Homan JM, Cimino JJ, Peters SG, Pickering BW, Herasevich V (2015) Point-of-care knowledge-based resource needs of clinicians: a survey from a large academic medical center. Appl Clin Inform 6(2):305–317. https://doi.org/10.4338/ACI-2014-11-RA-0104 CrossRefPubMedPubMedCentral

Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA (1991) Physicians’ information needs: analysis of questions posed during clinical teaching. Ann Intern Med 114(7):576–581. https://doi.org/10.7326/0003-4819-114-7-576 CrossRefPubMed

González-González AI, Dawes M, Sánchez-Mateos J et al (2007) Information needs and information-seeking behavior of primary care physicians. Ann Fam Med 5(4):345–352. https://doi.org/10.1370/afm.681 CrossRefPubMedPubMedCentral

10.

Green ML, Ciampi MA, Ellis PJ (2000) Residents’ medical information needs in clinic: are they being met? Am J Med 109(3):218–223. https://doi.org/10.1016/S0002-9343(00)00458-7 CrossRefPubMed

11.

Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME (2005) Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc 12(2):217–224. https://doi.org/10.1197/jamia.M1608 CrossRefPubMedPubMedCentral

12.

Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA (2002) Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ 324(7339):710. https://doi.org/10.1136/bmj.324.7339.710 CrossRefPubMedPubMedCentral

13.

Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342(8883):1317–1322. https://doi.org/10.1016/0140-6736(93)92244-N CrossRefPubMed

14.

Jagsi R, Huang G, Griffith K, Zikmund-Fisher BJ, Janz NK, Griggs JJ, Katz SJ, Hawley ST (2014) Attitudes toward and use of cancer management guidelines in a national sample of medical oncologists and surgeons. J Natl Compr Cancer Netw 12(2):204–212. https://doi.org/10.6004/jnccn.2014.0021 CrossRef

15.

Dillmon M, Goldberg JM, Ramalingam SS et al (2012) Clinical practice guidelines for cancer care: utilization and expectations of the practicing oncologist. J Oncol Pract 8(6):350–353 352 p following 353CrossRef

16.

Somerfield MR, Bohlke K, Browman GP, Denduluri N, Einhaus K, Hayes DF, Khorana AA, Miller RS, Mohile SG, Oliver TK, Ortiz E, Lyman GH (2016) Innovations in American Society of Clinical Oncology Practice Guideline Development. J Clin Oncol 34(26):3213–3220. https://doi.org/10.1200/JCO.2016.68.3524 CrossRefPubMed

17.

Han LC, Delpe S, Shah ND, Ziegenfuss JY, Tilburt JC, Karnes RJ, Nguyen PL, Gross CP, Yu JB, Trinh QD, Sun M, Ranasinghe WKB, Kim SP (2014) Perceptions of radiation oncologists and urologists on sources and type of evidence to inform prostate cancer treatment decisions. Int J Radiat Oncol Biol Phys 89(2):277–283. https://doi.org/10.1016/j.ijrobp.2014.02.001 CrossRefPubMed

18.

Fuller CD, Nijkamp J, Duppen JC, Rasch CR, Thomas CR Jr, Wang SJ, Okunieff P, Jones WE 3rd, Baseman D, Patel S, Demandante CG, Harris AM, Smith BD, Katz AW, McGann C, Harper JL, Chang DT, Smalley S, Marshall DT, Goodman KA, Papanikolaou N, Kachnic LA, Radiation Oncology Committee of the Southwest Oncology Group (2011) Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting. Int J Radiat Oncol Biol Phys 79(2):481–489. https://doi.org/10.1016/j.ijrobp.2009.11.012 CrossRefPubMed

19.

Mavroidis P, Giantsoudis D, Awan MJ, Nijkamp J, Rasch CR, Duppen JC, Thomas CR Jr, Okunieff P, Jones WE 3rd, Kachnic LA, Papanikolaou N, Fuller CD, Southwest Oncology Group Radiation Oncology Committee (2014) Consequences of anorectal cancer atlas implementation in the cooperative group setting: radiobiologic analysis of a prospective randomized in silico target delineation study. Radiother Oncol 112(3):418–424. https://doi.org/10.1016/j.radonc.2014.05.011 CrossRefPubMedPubMedCentral

20.

Skinner A (2007) Survey research: designing an instrument. Johns Hopkins Bloomberg School of Public Health, Baltimore

21.

AJ W, Bosch WR, Chang DT et al (2015) Expert consensus contouring guidelines for intensity modulated radiation therapy in esophageal and gastroesophageal junction cancer. Int J Radiat Oncol Biol Phys 92(4):911–920CrossRef

22.

Hong TS, Bosch WR, Krishnan S, Kim TK, Mamon HJ, Shyn P, Ben-Josef E, Seong J, Haddock MG, Cheng JC, Feng MU, Stephans KL, Roberge D, Crane C, Dawson LA (2014) Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines. Int J Radiat Oncol Biol Phys 89(4):804–813. https://doi.org/10.1016/j.ijrobp.2014.03.041 CrossRefPubMedPubMedCentral

23.

Brouwer CL, Steenbakkers RJ, Bourhis J et al (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117(1):83–90. https://doi.org/10.1016/j.radonc.2015.07.041 CrossRefPubMed

24.

Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, Grosu AL, Lagerwaard FJ, Minniti G, Mirimanoff RO, Ricardi U, Short SC, Weber DC, Belka C (2016) ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 118(1):35–42. https://doi.org/10.1016/j.radonc.2015.12.003 CrossRefPubMed

25.

Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, Sheehan J, Gerszten PC, Chang E, Gibbs I, Soltys S, Sahgal A, Deasy J, Flickinger J, Quader M, Mindea S, Yamada Y (2012) International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 83(5):e597–e605. https://doi.org/10.1016/j.ijrobp.2012.03.009 CrossRefPubMed

26.

Illidge T, Specht L, Yahalom J, Aleman B, Berthelsen AK, Constine L, Dabaja B, Dharmarajan K, Ng A, Ricardi U, Wirth A (2014) Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 89(1):49–58. https://doi.org/10.1016/j.ijrobp.2014.01.006 CrossRefPubMed

27.

Yahalom J, Illidge T, Specht L, Hoppe RT, Li YX, Tsang R, Wirth A (2015) Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 92(1):11–31. https://doi.org/10.1016/j.ijrobp.2015.01.009 CrossRefPubMed

28.

Kastner M, Bhattacharyya O, Hayden L, Makarski J, Estey E, Durocher L, Chatterjee A, Perrier L, Graham ID, Straus SE, Zwarenstein M, Brouwers M (2015) Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review. J Clin Epidemiol 68(5):498–509. https://doi.org/10.1016/j.jclinepi.2014.12.013 CrossRefPubMed

29.

Lefresne S, Olivotto IA, Joe H, Blood PA, Olson RA (2013) Impact of quality assurance rounds in a Canadian radiation therapy department. Int J Radiat Oncol Biol Phys 85(3):e117–e121. https://doi.org/10.1016/j.ijrobp.2012.10.015 CrossRefPubMed

30.

Bennett CL, Somerfield MR, Pfister DG, Tomori C, Yakren S, Bach PB, American Society of Clinical Oncology (2003) Perspectives on the value of American Society of Clinical Oncology clinical guidelines as reported by oncologists and health maintenance organizations. J Clin Oncol 21(5):937–941. https://doi.org/10.1200/JCO.2003.07.165 CrossRefPubMed

31.

Grimshaw JM, Thomas RE, MacLennan G et al (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8(6):iii–iiv 1-72CrossRef

32.

Stafford RS, Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Furberg CD, Piller LB, Pressel SL, Whelton PK, ALLHAT Collaborative Research Group (2010) Impact of the ALLHAT/JNC7 dissemination project on thiazide-type diuretic use. Arch Intern Med 170(10):851–858. https://doi.org/10.1001/archinternmed.2010.130 CrossRefPubMedPubMedCentral

33.

Flynn S, Hebert P, Korenstein D, Ryan M, Jordan WB, Keyhani S (2017) Leveraging social media to promote evidence-based continuing medical education. PLoS One 12(1):e0168962. https://doi.org/10.1371/journal.pone.0168962 CrossRefPubMedPubMedCentral

34.

Ibrahim AM, Lillemoe KD, Klingensmith ME, Dimick JB (2017) Visual abstracts to disseminate research on social media: a prospective, case-control crossover study. Ann Surg 266(6):e46–e48. https://doi.org/10.1097/SLA.0000000000002277 CrossRefPubMed

35.

Bonis PA, Pickens GT, Rind DM et al (2008) Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform 77(11):745–753. https://doi.org/10.1016/j.ijmedinf.2008.04.002 CrossRefPubMed

36.

Isaac T, Zheng J, Jha A (2012) Use of UpToDate and outcomes in US hospitals. J Hosp Med 7(2):85–90. https://doi.org/10.1002/jhm.944 CrossRefPubMed

37.

Gillespie EF, Panjwani N, Golden DW, Gunther JR, Chapman TR, Brower JV, Kosztyla R, Bykowski JM, Sanghvi P, Murphy JD (2016) Multi-institutional randomized trial testing the utility of an interactive three-dimensional contouring atlas among radiation oncology residents. Int J Radiat Oncol Biol Phys 96(2):E416–E417. https://doi.org/10.1016/j.ijrobp.2016.06.1677 CrossRef

Title: Assessment of contouring resource use and awareness of contouring guidelines among radiation oncologists
Publication date: 01-03-2018
Published in: Journal of Radiation Oncology / Issue 1/2018
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-018-0343-x

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