Outcomes Study Shows Barriers to Optimal Management of Cancer May Contribute to Gaps in Care

Despite all of the breakthroughs and advances in the prevention, diagnosis and treatment of cancer over the past several decades, a recent study conducted by CE Outcomes showed that oncologists still perceive a number of barriers to optimal management of breast, colorectal, and lung Cancer. The study, explained that “even with the availability of clinical practice guidelines and new agents designed for the treatment of cancer, gaps in optimal healthcare and cancer management in the US have been consistently reported.” The study suggested that “barriers to optimal management of cancer may contribute to these gaps in care.”


Consequently, to determine exactly what barriers exist, the study conducted nominal group technique (NGT) sessions with United States-practicing medical and surgical oncologists. The NGT is a “facilitated systematic and structured group approach to elicit and prioritize the responses of a panel addressing complex issues, and has been applied to analysis of continuing medical education (CME).” The sessions involve the following steps:


1) Silent written generation of responses to a question;

2) Round-robin recording of responses;

3) Discussion for clarification and aggregation;

4) Prioritization of responses.


Two NGT sessions for each of the tumor types (6 panels in all addressing breast, colorectal, and non-small cell lung cancer) were conducted with a combined total of 44 physicians. The panels were asked to generate a list of barriers that they and their colleagues face when managing these cancer types, followed by prioritization of the barriers with the greatest impact on management and barriers best addressed by CME.


The prioritization allowed each panelist to weigh the most important responses with a score — the response perceived as top priority was awarded 3 points; second priority, 2 points; third, 1 point. The study then aggregated the results in order to identify key barriers oncologists perceive when managing patients with breast, colorectal, and non-small cell lung cancer (NSCLC).


Once aggregated, the barriers all 6 sessions were classified into categories and subcategories. Each category was weighted based on the accumulated prioritization scores of each barrier response to show key areas of concern for oncologists, including top overall barriers and those that can best be addressed by CME. The categories of top barriers to address by CME included:




   Complexities of therapeutic management



The study found that while barriers elicited from medical and surgical oncologists were well-distributed within each of the categories, certain categories projected as more important when prioritized. The study also found that weighted proportions of barriers change when considering top barriers and those best addressed by CME.


For example, Cognitive/ behavioral– and guideline/evidence-based barriers increase in weight when education is considered. Oncologists view these topics as important areas that are well-suited for future CME. That is because the issues in this category capture knowledge, which is well-covered by traditional CME. The barrier viewed as most important for CME was to address a lack of early and accurate staging, which was highlighted in each session.


On the other hand, barriers associated with system/process and complexeties of therapeutic management were perceived as important, but may not be as easy for CME to address.


Overall, oncologists perceived that educational interventions were best suited to manage cognitive/behavioral and guideline/evidence barriers. Within these categories, oncologists viewed the most important topics to be on early and accurate staging, increased understanding of all available treatment options, and improved data on treatment of rectal cancer and optimal duration of breast cancer treatment.


Other barriers more related to the medical system or the specific individual difficulties in managing cancer were also viewed as important areas to address by CME. Such topics include education on ensuring timely referral and multidisciplinary communication.


Ultimately, with “over 560,000 new cases of breast, colorectal, and lung cancer estimated to occur within the United States in 2009,” these findings show that there is a great need for CME. These CME programs should be designed to address the barriers oncologists are facing to help them overcome the gaps in care and knowledge they are experiencing.

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