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Abstract：
BACKGROUND: The introduction of new targeted therapies for RET-altered lung and thyroid cancers (LC/TC) has impacted pathologists\' practice by making genomic testing more relevant. Variations in health systems and treatment access result in distinct clinical challenges and barriers. This study aimed to assess practice gaps and challenges experienced by pathologists involved in the diagnosis of RET-altered LC/TC, including biomarker testing, to inform educational solutions.
METHODS: Pathologists in Germany, Japan, the UK, and US participated in this ethics-approved mixed-methods study, which included interviews and surveys (data collected January-March 2020). Qualitative data was thematically analysed, quantitative data was analysed with chi-square and Kruskal-Wallis H-tests, and both were triangulated.
RESULTS: A total of 107 pathologists took part in this study. Knowledge gaps were reported regarding genomic testing for LC/TC in Japan (79/60%), the UK (73/66%), and the US (53/30%). Skill gaps were reported when selecting genomic biomarker tests to diagnose TC in Japan (79%), the UK (73%) and US (57%) and when performing specific biomarker tests, especially in Japan (82% for RET) and in the UK (75% for RET). Japanese participants (80%) reported uncertainty about what information to share with the multidisciplinary team to ensure optimal patient-centered care. At the time of data collection, pathologists in Japan faced access barriers to using RET biomarker tests: only 28% agreed that there are relevant RET genomic biomarker tests available in Japan, versus 67% to 90% in other countries.
CONCLUSIONS: This study identified areas where pathologists need additional continuing professional development opportunities to enhance their competencies and better support delivery of care to patients with RET-altered lung or thyroid tumours. Addressing identified gaps and improving competencies of pathologists in this field should be emphasised in continuing medical education curricula and through quality improvement initiatives. Strategies deployed on an institutional and health system level should aim to improve interprofessional communication and genetic biomarker testing expertise.
METHODS: Pathologists in Germany, Japan, the UK, and US participated in this ethics-approved mixed-methods study, which included interviews and surveys (data collected January-March 2020). Qualitative data was thematically analysed, quantitative data was analysed with chi-square and Kruskal-Wallis H-tests, and both were triangulated.
RESULTS: A total of 107 pathologists took part in this study. Knowledge gaps were reported regarding genomic testing for LC/TC in Japan (79/60%), the UK (73/66%), and the US (53/30%). Skill gaps were reported when selecting genomic biomarker tests to diagnose TC in Japan (79%), the UK (73%) and US (57%) and when performing specific biomarker tests, especially in Japan (82% for RET) and in the UK (75% for RET). Japanese participants (80%) reported uncertainty about what information to share with the multidisciplinary team to ensure optimal patient-centered care. At the time of data collection, pathologists in Japan faced access barriers to using RET biomarker tests: only 28% agreed that there are relevant RET genomic biomarker tests available in Japan, versus 67% to 90% in other countries.
CONCLUSIONS: This study identified areas where pathologists need additional continuing professional development opportunities to enhance their competencies and better support delivery of care to patients with RET-altered lung or thyroid tumours. Addressing identified gaps and improving competencies of pathologists in this field should be emphasised in continuing medical education curricula and through quality improvement initiatives. Strategies deployed on an institutional and health system level should aim to improve interprofessional communication and genetic biomarker testing expertise.
摘要：
背景：针对RET改变的肺癌和甲状腺癌（LC/TC）的新靶向疗法的引入通过使基因组测试更加相关而影响了病理学家的实践。卫生系统和治疗准入的变化导致不同的临床挑战和障碍。本研究旨在评估参与RET改变的LC/TC诊断的病理学家所经历的实践差距和挑战。包括生物标志物测试，告知教育解决方案。
方法：德国的病理学家，Japan,英国,美国参加了这项伦理批准的混合方法研究，其中包括访谈和调查（2020年1月至3月收集的数据）。定性数据进行了主题分析，用卡方检验和Kruskal-WallisH检验分析定量数据，两者都是三角测量的。
结果：共有107名病理学家参与了这项研究。据报道，日本关于LC/TC基因组检测的知识差距(79/60%)，英国（73/66%），美国（53/30%）。在日本选择基因组生物标志物测试来诊断TC时，技能差距被报告（79%），英国(73%)和美国(57%)，在进行特定的生物标志物测试时，特别是在日本(82%为RET)和英国(75%为RET)。日本参与者（80％）报告了与多学科团队共享哪些信息以确保以患者为中心的最佳护理的不确定性。在收集数据的时候,日本的病理学家面临使用RET生物标志物测试的障碍：只有28％的人同意日本有相关的RET基因组生物标志物测试，而其他国家的67%到90%。
结论：本研究确定了病理学家需要额外的持续专业发展机会的领域，以提高他们的能力并更好地支持对RET改变的肺或甲状腺肿瘤患者的治疗。在继续医学教育课程和质量改进计划中，应强调解决已发现的差距并提高病理学家在该领域的能力。在机构和卫生系统一级部署的战略应旨在改善专业间的交流和遗传生物标志物测试专业知识。
方法：德国的病理学家，Japan,英国,美国参加了这项伦理批准的混合方法研究，其中包括访谈和调查（2020年1月至3月收集的数据）。定性数据进行了主题分析，用卡方检验和Kruskal-WallisH检验分析定量数据，两者都是三角测量的。
结果：共有107名病理学家参与了这项研究。据报道，日本关于LC/TC基因组检测的知识差距(79/60%)，英国（73/66%），美国（53/30%）。在日本选择基因组生物标志物测试来诊断TC时，技能差距被报告（79%），英国(73%)和美国(57%)，在进行特定的生物标志物测试时，特别是在日本(82%为RET)和英国(75%为RET)。日本参与者（80％）报告了与多学科团队共享哪些信息以确保以患者为中心的最佳护理的不确定性。在收集数据的时候,日本的病理学家面临使用RET生物标志物测试的障碍：只有28％的人同意日本有相关的RET基因组生物标志物测试，而其他国家的67%到90%。
结论：本研究确定了病理学家需要额外的持续专业发展机会的领域，以提高他们的能力并更好地支持对RET改变的肺或甲状腺肿瘤患者的治疗。在继续医学教育课程和质量改进计划中，应强调解决已发现的差距并提高病理学家在该领域的能力。在机构和卫生系统一级部署的战略应旨在改善专业间的交流和遗传生物标志物测试专业知识。
