Oncologists' Perspectives on Oncology Stewardship: A Focus Group Exploration in a Statewide Quality Improvement...

Multiple resource utilization challenges impact hematology-oncology practices including the expanding number of novel cancer-directed therapies, increasing costs of care, and imbalances in access to care. Oncology stewardship is a comprehensive approach to addressing these challenges while focusing on improving patient outcomes, enhancing quality of life, and optimizing resource utilization.

The purpose of this project was to explore oncologists' perceptions of oncology stewardship and a potential statewide oncology stewardship program through the Michigan Oncology Quality Consortium (MOQC).

We conducted two structured focus groups with hematology-oncology physicians to elicit perspectives on goals and principles behind oncology stewardship, behaviors surrounding the implementation of novel therapies in the face of rising healthcare costs, and operationalization and barriers of an oncology stewardship program. Members of both focus groups then gathered for a final member checking session where findings were comprehensively presented and reviewed.

Collectively, 13 physician participants (n=8 first session, n=5 second session) represented 5 of the 6 MOQC regions in the sessions. Physicians practiced in both hematology (n=4) and medical oncology (n=10). Four participants were members of small practices (1-5 physicians), 1 was from a medium practice (6-14 physicians), and 8 were from large practices (15 or more physicians). Participants endorsed the tenets of stewardship as presented. Cognitive dissonance was also observed between their stated preference for rigorous trial evidence for drug approvals, and their incorporation of new approvals in the clinical scenarios presented. The large influence of national guidelines for selecting new therapies was emphasized in this context. Oncology stewardship has the potential to clarify the value and sequence of therapies at individual and societal levels. Participants indicated interest in resources to evaluate data for new approvals in a standardized fashion in the context of other available therapies.

Participants endorsed stewardship principles, emphasized reliance on national guidelines for selecting novel therapies, and supported a program for consistent, high-quality care through evidence-based resources to reduce treatment variability across the state.