PDF(Pubmed)
Abstract：
BACKGROUND: We aimed to assess contouring-related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual- and organization-level factors.
METHODS: We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis.
RESULTS: Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02).
CONCLUSIONS: Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.
METHODS: We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis.
RESULTS: Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02).
CONCLUSIONS: Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.
摘要：
背景：我们旨在评估美国放射肿瘤学家的轮廓相关实践，并探讨资源的获取和使用以及质量改进策略如何根据个人和组织层面的因素而有所不同。
方法：我们进行了一项采用序贯解释性设计的混合方法研究。调查通过电子邮件发送给美国放射肿瘤学家的随机10％样本。参与的医生被邀请参加半结构化访谈。使用Kruskal-Wallis和Wilcoxon秩和检验以及多变量回归模型来评估关联。采访数据使用主题内容分析进行编码。
结果：调查总应答率为24%，随后的完成率为97%。在73%的受访者中，≥50%的临床病例出现轮廓相关问题。首先访问的资源包括已发布的地图集（75％），然后咨询另一位放射肿瘤学家（60％）。通才比疾病现场专家更容易获得共识指南（P=0.04），而eContour.org更常被通才(OR4.3，95%CI1.2-14.8)和年轻医生(每增加5年OR1.33，95%CI1.08-1.67）。医生报告的优化轮廓质量的常见障碍是时间限制（58％）和缺乏疾病现场专家（21％）。40%（40%，n=14）无法获得疾病现场专家的医生表示，这可以促进采用新疗法。几乎所有（97％）的受访者都有正式的同行评审，但只有43%的人有特定的轮廓审查，这在学术中心更常见(P=0.02)。
结论：改善辐射等高线质量的潜在机会包括改善与疾病现场专家的接触和针对等高线的同行评审。设计新策略时必须考虑医生的时间。
方法：我们进行了一项采用序贯解释性设计的混合方法研究。调查通过电子邮件发送给美国放射肿瘤学家的随机10％样本。参与的医生被邀请参加半结构化访谈。使用Kruskal-Wallis和Wilcoxon秩和检验以及多变量回归模型来评估关联。采访数据使用主题内容分析进行编码。
结果：调查总应答率为24%，随后的完成率为97%。在73%的受访者中，≥50%的临床病例出现轮廓相关问题。首先访问的资源包括已发布的地图集（75％），然后咨询另一位放射肿瘤学家（60％）。通才比疾病现场专家更容易获得共识指南（P=0.04），而eContour.org更常被通才(OR4.3，95%CI1.2-14.8)和年轻医生(每增加5年OR1.33，95%CI1.08-1.67）。医生报告的优化轮廓质量的常见障碍是时间限制（58％）和缺乏疾病现场专家（21％）。40%（40%，n=14）无法获得疾病现场专家的医生表示，这可以促进采用新疗法。几乎所有（97％）的受访者都有正式的同行评审，但只有43%的人有特定的轮廓审查，这在学术中心更常见(P=0.02)。
结论：改善辐射等高线质量的潜在机会包括改善与疾病现场专家的接触和针对等高线的同行评审。设计新策略时必须考虑医生的时间。
