Prostate Cancer Imaging Stewardship: a multimodal, physician-centered intervention for guideline-concordant imaging

Area of Science:

• Oncology
• Radiology
• Health Services Research

Background:

• Inappropriate imaging for low-risk prostate cancer is a significant concern for low-value care.
• The Prostate Cancer Imaging Stewardship (PCIS) intervention was developed to address this issue.
• Guideline-concordant imaging is crucial for effective prostate cancer management.

Purpose of the Study:

• To determine the effectiveness of the PCIS intervention in promoting guideline-concordant imaging for prostate cancer.
• To reduce the incidence of low-value nuclear medicine bone scans (NMBS) in low-risk prostate cancer patients.
• To assess the impact of PCIS on necessary imaging for high-risk prostate cancer patients.

Main Methods:

• A stepped-wedge, cluster-randomized trial was conducted across ten Veterans Health Administration medical centers from March 2018 to March 2021.
• The PCIS intervention utilized three evidence-based strategies: clinical reminder order checks, academic detailing, and audit and feedback.
• Outcomes were assessed in 2,302 patients with incident prostate cancer, focusing on guideline-discordant NMBS imaging.

Main Results:

• During the control period, 20.4% of patients not requiring NMBS received guideline-discordant imaging, compared to 14.9% during the intervention period (OR=0.54, p=0.04).
• For patients requiring NMBS, 6.8% did not receive one during control versus 5.5% during intervention (OR=1.36, p=0.36).
• The intervention significantly reduced unnecessary NMBS in low-risk patients.

Conclusions:

• The PCIS intervention effectively reduced low-value, guideline-discordant nuclear medicine bone scan imaging in low-risk prostate cancer patients.
• The intervention did not negatively affect the ordering of necessary imaging for high-risk prostate cancer patients.
• PCIS represents a successful strategy for improving imaging stewardship in oncology.