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. 2020 May;42(5):974-987.
doi: 10.1002/hed.26071. Epub 2020 Jan 10.

Perceived value drives use of routine asymptomatic surveillance PET/CT by physicians who treat head and neck cancer

Benjamin R Roman  1 , Shivangi Lohia  1 , Nandita Mitra  2 , Marilene B Wang  3 , Anna M Pou  4 , F Christopher Holsinger  5 , David Myssiorek  6 , David Goldenberg  7 , David A Asch  2 , Judy A Shea  2
Affiliations

Perceived value drives use of routine asymptomatic surveillance PET/CT by physicians who treat head and neck cancer

Benjamin R Roman et al. Head Neck. 2020 May.

Abstract

Background: Why physicians use surveillance imaging for asymptomatic cancer survivors despite recommendations against this is not known.

Methods: Physicians surveilling head and neck cancer survivors were surveyed to determine relationships among attitudes, beliefs, guideline familiarity, and self-reported surveillance positron-emission-tomography/computed-tomography use.

Results: Among 459 responses, 79% reported using PET/CT on some asymptomatic patients; 39% reported using PET/CT on more than half of patients. Among attitudes/beliefs, perceived value of surveillance imaging (O.R. 3.57, C.I. 2.42-5.27, P = <.0001) was the strongest predictor of high imaging, including beliefs about outcome (improved survival) and psychological benefits (reassurance, better communication). Twenty-four percent of physicians were unfamiliar with guideline recommendations against routine surveillance imaging. Among physicians with high perceived-value scores, those less familiar with guidelines imaged more (O.R. 3.55, C.I. 1.08-11.67, P = .037).

Conclusions: Interventions to decrease routine surveillance PET/CT use for asymptomatic patients must overcome physicians' misperceptions of its value. Education about guidelines may modify the effect of perceived value.

Keywords: PET/CT; head and neck cancer; physician decision-making; surveillance imaging; value.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors report no other financial disclosures or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Categories and domains of reasons for using surveillance PET/CT scans in asymptomatic patients. We identified 11 categories of attitudes and beliefs that were thought to influence routine surveillance PET/CT use in asymptomatic patients. Those that grouped a priori with the TPB domains of outcome expectancy, perceived control, and normative beliefs are highlighted in yellow. We identified additional categories related to innovativeness, and reasons for decreased use. The 11 categories were used to write 40 Likert attitude and belief items. Through factor analysis, four factorial domains were identified from the items (outlined and numbered), the first two of which align with TPB domains: domain 1 we call perceived value; domain 2 we call external pressures; domain 3 we call cost-consciousness and holistic; domain 4 we call innovativeness
FIGURE 2
FIGURE 2
CONSORT-type Diagram
FIGURE 3
FIGURE 3
Self-reported use of PET/CT for routine surveillance imaging in asymptomatic patients. Following a single clinical scenario, physicians were asked, “What percentage of your head and neck cancer patients get routine surveillance PET/CT scans?” n = 459
FIGURE 4
FIGURE 4
Physicians’ estimates of survival benefit from routine surveillance PET/CT scans. Physicians were asked to estimate the percentage of asymptomatic patients getting routine surveillance imaging who might experience a survival benefit
See this image and copyright information in PMC

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