Dataset Information

Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies.

ABSTRACT:

Background

Many men with prostate cancer will be exposed to androgen deprivation therapy (ADT). While evidence-based ADT use is common, ADT is also used in cases with no or limited evidence resulting in more harm than benefit, i.e., overuse. Since there are risks of ADT (e.g., diabetes, osteoporosis), it is important to understand the behaviors facilitating overuse to inform de-implementation strategies. For these reasons, we conducted a theory-informed survey study, including a discrete choice experiment (DCE), to better understand ADT overuse and provider preferences for mitigating overuse.

Methods

Our survey used the Action, Actor, Context, Target, Time (AACTT) framework, the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation-Behavior (COM-B) Model, and a DCE to elicit provider de-implementation strategy preferences. We surveyed the Society of Government Service Urologists listserv in December 2020. We stratified respondents based on the likelihood of stopping overuse as ADT monotherapy for localized prostate cancer ("yes"/"probably yes," "probably no"/"no"), and characterized corresponding Likert scale responses to seven COM-B statements. We used multivariable regression to identify associations between stopping ADT overuse and COM-B responses.

Results

Our survey was completed by 84 respondents (13% response rate), with 27% indicating "probably no"/"no" to stopping ADT overuse. We found differences across respondents who said they would and would not stop ADT overuse in demographics and COM-B statements. Our model identified 2 COM-B domains (Opportunity-Social, Motivation-Reflective) significantly associated with a lower likelihood of stopping ADT overuse. Our DCE demonstrated in-person communication, multidisciplinary review, and medical record documentation may be effective in reducing ADT overuse.

Conclusions

Our study used a behavioral theory-informed survey, including a DCE, to identify behaviors and context underpinning ADT overuse. Specifying behaviors supporting and gathering provider preferences in addressing ADT overuse requires a stepwise, stakeholder-engaged approach to support evidence-based cancer care. From this work, we are pursuing targeted improvement strategies.

Trial registration

ClinicalTrials.gov, NCT03579680.

SUBMITTER: Skolarus TA

PROVIDER: S-EPMC11005280 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies.

Skolarus Ted A TA Hawley Sarah T ST Forman Jane J Sales Anne E AE Sparks Jordan B JB Metreger Tabitha T Burns Jennifer J Caram Megan V MV Radhakrishnan Archana A Dossett Lesly A LA Makarov Danil V DV Leppert John T JT Shelton Jeremy B JB Stensland Kristian D KD Dunsmore Jennifer J Maclennan Steven S Saini Sameer S Hollenbeck Brent K BK Shahinian Vahakn V Wittmann Daniela A DA Deolankar Varad V Sriram S S

Implementation science communications 20240409 1

<h4>Background</h4>Many men with prostate cancer will be exposed to androgen deprivation therapy (ADT). While evidence-based ADT use is common, ADT is also used in cases with no or limited evidence resulting in more harm than benefit, i.e., overuse. Since there are risks of ADT (e.g., diabetes, osteoporosis), it is important to understand the behaviors facilitating overuse to inform de-implementation strategies. For these reasons, we conducted a theory-informed survey study, including a discrete ...[more]

PMID: 38594740

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Dataset Information

Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies.

Background

Methods

Results

Conclusions

Trial registration

Publications

Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies.

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