Barriers to physician adherence to evidence-based monitoring guidelines in chronic myelogenous leukemia
Stuart L Goldberg1, Luke P Akard2, Michael J Dugan2
1John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN sgoldberg@hackensackumc.org.
Insights
Physician adherence to chronic myelogenous leukemia (CML) monitoring guidelines is low due to barriers like cost and time. Multifaceted educational strategies are needed to improve CML patient outcomes.
Area of Science:
- Hematology
- Oncology
- Clinical Practice Guidelines
Background:
- Monitoring cytogenetic/molecular responses in chronic myelogenous leukemia (CML) is crucial for superior patient outcomes.
- Current adherence to published evidence-based CML monitoring guidelines is suboptimal, with less than half of patients monitored appropriately.
- Barriers contributing to low physician adherence with CML monitoring guidelines are not well understood.
Purpose of the Study:
- To investigate physician attitudes toward monitoring guidelines in chronic myelogenous leukemia (CML).
- To identify barriers to physician adherence with evidence-based CML monitoring guidelines.
Main Methods:
- An anonymous survey was distributed to 515 hematologist-oncologists in New Jersey and Indiana.
- The survey explored physician attitudes regarding the use and barriers to implementing CML monitoring guidelines.
Main Results:
- Of 96 respondents, 84% reported using CML monitoring guidelines, but only 54% found them easy to access and 51% felt they covered all disease aspects.
- Patient-related cost barriers (30%) and physician time constraints (20%) were significant deterrents to guideline implementation.
- While 90% favored an online database, many were not motivated by additional training or expert consultations.
Conclusions:
- Significant barriers, including resource limitations, lack of familiarity, and disagreement with guidelines, hinder adherence in CML management.
- Current efforts to facilitate guideline use may not be desired by physicians.
- Multifaceted educational interventions, such as point-of-care computerized reminders, are necessary to enhance CML care quality.
Purpose:
Although monitoring of cytogenetic/molecular responses to therapy in chronic myelogenous leukemia (CML) facilitates superior outcomes, less than one half of CML patients are monitored using published evidence-based guidelines. Barriers to physician adherence with guidelines are unknown.
Methods:
An anonymous survey was mailed to 515 hematologist-oncologists in New Jersey and Indiana exploring attitudes toward monitoring guidelines.
Results:
Ninety-six physicians (19%) responded-89% in community practice, 83% with more than 10 years of experience, and 92% caring for CML patients. Eighty-four percent self-reported using CML monitoring guidelines, 14% were familiar with but did not adopt guidelines and 2% were unfamiliar. Eighty-four percent performed molecular monitoring quarterly as recommended; 6% did not perform molecular monitoring at all during the first year. Guidelines were considered evidence based by 98%, but only 54% strongly considered them easy to find; only 51% strongly felt they addressed all aspects of disease management. Patient resource barriers were a significant deterrent toward implementation with 30% citing high costs. Physician resources, including lack of time to search guidelines, limited use in one fifth. Despite 90% believing an online database helpful, between one third and one half did not feel that additional training, professional society endorsements, or availability of expert consultations would encourage use.
Conclusions:
Significant barriers to adherence with evidence-based CML guidelines exist. Resource barriers, lack of familiarity and lack of agreement restrict adoption, but efforts to facilitate use are not desired. Multifaceted educational strategies, including automated computerized reminders at point of care, are needed to improve quality outcomes in CML.
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