Researchers identify behavioral determinants impacting provider decisions to prescribe low-value ADT for patients with prostate cancer, according to results presented at the virtual 2020 Association of VA Hematology/Oncology (AVAHO) Annual Meeting.
“Men with prostate cancer are often treated with androgen deprivation therapy (ADT). While ADT monotherapy is not appropriate treatment for most localized prostate cancer, it continues to be used raising questions of low-value care,” wrote Ted Skolarus, MD, MPH, FACS, University of Michigan, VA Ann Arbor Healthcare System, and colleagues.
In order to identify determinants of low-value ADT use and opportunities for deimplementation strategy development, Dr Skolarus and colleagues conducted a qualitative analysis guided by the Theoretical Domains Framework (TDF) and the Behavior Change Wheel’s Capability, Opportunity, Motivation Model (COM-B).
Using VA national cancer registry and administrative data from 2016 to 2017, researchers selected facilities with the highest and lowest rates of ADT monotherapy as treatment for localized prostate cancer.
Purposive sampling was used to select high and low performing sites. In order to generate a conceptual framework of provider approaches to low-value ADT, TDF domains were mapped to the COM-B Model. The conceptual model characterized 3 groups of providers based on low-value ADT use: never prescribe, wiling, and routinely prescribe as an acceptable treatment option.
Providers in all groups demonstrated knowledge of appropriate localized prostate cancer treatment options and interpersonal skills to engage patients in educational discussions.
Provider motivation to prescribe low-value ADT depended on goals of care, including patient preferences, view of their role, and beliefs about benefits and harms of ADT.
Additionally, researchers noted that access to resources, such as guidelines and interdisciplinary colleagues, as well as advice from peers were influential factors in providers’ decision making.
“Behavioral theory-based characterization of provider practices helps clarify determinants implicated in provider decisions to prescribe low value ADT,” Dr Skolarus and colleagues concluded.—Janelle Bradley
Skolarus T, Foreman J, Sparks JB, et al. Understanding De-Implementation of Low Value Castration for Men With Prostate Cancer. Presented at: the Virtual 2020 AVAHO Annual Meeting; Sept 12-13, 2020. Abstract 54.
