M Švecová, K Fiedlerová, M Mareková, K Dubayová
Potential application of body fluids autofluorescence in the non-invasive diagnosis of endometrial cancer
Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti
patients nonspine bone metastases shortcourse radiotherapy rt reduce patient burden without sacrificing clinical benefit however great variation uptake shortcourse rt across practice settings evaluate whether set 3 implementation strategies facilitates increased adoption consensus recommendation treat nonspine bone metastases shortcourse rt ie 5 fractions prospective steppedwedge cluster randomized quality improvement study conducted 3 communitybased cancer centers within existing academiccommunity partnership rollout initiated 3month increments october 2021 may 2022 participants included treating physicians patients receiving rt nonspine bone metastases data analysis performed october 2022 may 2023 three implementation strategies1 dissemination published consensus guidelines 2 personalized auditandfeedback reports 3 emailbased electronic consultation platform econsultwere rolled physicians primary outcome adherence consensus recommendation shortcourse rt nonspine bone metastases mixedeffects logistic regression bone metastasis level used model associations exposure physicians set strategies preimplementation vs postimplementation shortcourse rt accounting patient physician characteristics calendar time random effect physician physician surveys administered implementation implementation assess feasibility acceptability appropriateness strategy fortyfive physicians treated 714 patients median iqr age treatment start 67 5975 years 343 women 48 838 unique nonspine bone metastases study period implementing set strategies associated use shortcourse rt odds ratio 078 95 ci 045134 p 40 unadjusted adherence rates 53 444 lesions preimplementation vs 56 469 lesions postimplementation however adjusted odds adherence increased calendar time odds ratio 168 95 ci 120236 p 003 3 implementation strategies perceived feasible acceptable appropriate perception auditandfeedback appropriateness changed vs implementation 19 29 physicians 66 vs 27 30 physicians 90 p 03 fisher exact test 20 physicians 67 preferring reports quarterly quality improvement study multicomponent set implementation strategies associated increased use shortcourse rt within academiccommunity partnership however practice improved time perhaps owing secular trends physician awareness study auditandfeedback appropriate anticipated findings support need investigate optimal approaches promoting evidencebased radiation practice across settings