A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer: Beyond the Abstract

Almost half of men with low-risk, localized prostate cancer receive guideline-discordant, unnecessary imaging. Professional organizations and societies unanimously agree that men with low risk prostate cancer should not get imaging. Our research team wanted to know why this is happening. Specifically, we wanted to know who (physicians or patients) was driving up these rates. In order to answer this research question, we chose qualitative research methods. This methodology is useful to understand what people think, how they feel, and why they behave the way they do.

We interviewed 17 physicians caring for men with prostate cancer and 22 patients with low risk prostate cancer (39 total) at three Veterans Administration medical centers. We found that physicians, not patients, were influencing imaging rates. Patients tended to trust their doctor, were more interested in the cancer treatment, and many could not remember if they had imaging at all. Alternatively, physicians reported that they were aware of the guidelines but often followed their own intuition, directions from imaging-avid colleagues, or the medical facility’s tendency to image more or less. They also reported a fear of “missing something” as well as medico-legal concerns.

Our research team’s ultimate goal is to ensure that men with prostate cancer receive high quality, evidence based care. Our findings from this research will inform the next iteration of our work.

Written By: Erica Sedlander, MPH, Department of Urology, NYU Langone Medical Center & Department of Population Health, NYU Langone Medical Center, New York, NY

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