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Research article
Soohyun Hwang
University of North Carolina at Chapel Hill
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6542-0565
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting.
Methods: We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for in
Results: Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation.
Conclusions: Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.
Keywords
active surveillance, prostate cancer, adoption, barriers, low-risk disease
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CURRENT STATUS: Published
View the published article at BMC Cancer.
Version 2
Posted 14 Aug, 2020
No community comments so far
Review #2 received
Received 20 Nov, 2020
Reviewer #3 agreed
On 11 Nov, 2020
Reviewer #2 agreed
On 09 Nov, 2020
Review #1 received
Received 14 Aug, 2020
Reviewer #1 agreed
On 13 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Editor assigned
On 11 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Editor invited
On 10 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 27 Jul, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #1 agreed
On 28 Jun, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Soohyun Hwang
University of North Carolina at Chapel Hill
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6542-0565
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cancer.
Version 2
Posted 14 Aug, 2020
No community comments so far
Review #2 received
Received 20 Nov, 2020
Reviewer #3 agreed
On 11 Nov, 2020
Reviewer #2 agreed
On 09 Nov, 2020
Review #1 received
Received 14 Aug, 2020
Reviewer #1 agreed
On 13 Aug, 2020
Reviewers invited
Invitations sent on 12 Aug, 2020
Editor assigned
On 11 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Editor invited
On 10 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 27 Jul, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #1 agreed
On 28 Jun, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cancer.
Background: Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting.
Methods: We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for in
Results: Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation.
Conclusions: Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.
Figure 1
Figure 2
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