Impact of Social contagion on Physician use of unproven cancer interventions

社会传染对医生使用未经证实的癌症干预措施的影响

• 批准号: 9143060
• 负责人: Cary P. Gross
• 金额: $ 53.32万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-19 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9143060
• 关键词: Address; Adjuvant; Adopted; Adoption; Affect; Behavior; Breast; Cancer Intervention; Caring; Characteristics; Clinical; Communication; Complex; Diagnostic; Diagnostic radiologic examination; Diffuse; Diffusion; Diffusion of Innovation; Direct Costs; Evaluation; Fractionated radiotherapy; Goals; Guidelines; Health; Health system; Image; Individual; Internet; Intervention; Investigation; Light; Link; Magnetic Resonance Imaging; Malignant Neoplasms; Medical; Medicare; Metastatic Neoplasm to the Bone; Methods; Modeling; Nature; Outcome; Patient Care; Patients; Pattern; Patterns of Care; Physician' s Role; Physicians; Policies; Population; Positron-Emission Tomography; Property; Provider; Radiation; Radiation Oncologist; Radiation therapy; Role; Shapes; Social Concepts; Social Impacts; Social Sciences; Structure; System; Technology; Testing; Therapeutic Radiology specialty; Time; Woman; Work; behavior change; behavior influence; beneficiary; cancer care; clinical care; clinical practice; contagion; cost; driving behavior; economic impact; individual patient; ineffective therapies; innovation; malignant breast neoplasm; new technology; novel; novel strategies; palliative; panacea; payment; peer; public health relevance; social; standard of care

DESCRIPTION (provided by applicant): Efforts to align cancer care with the best available medical evidence have largely focused on disseminating guidelines, enhancing physician-patient communication, and revising payment schema. Although these are critical strategies, it is possible that another major influence on physician behavior has been overlooked - what if the practice of a physician's peers was a major determinant of whether she or he adopts one new cancer intervention or abandons another? We propose a novel investigation of the impact of physicians and physician patient-sharing networks on the adoption and abandonment of cancer interventions. Physician networks are groups of physicians who work with one another either directly or indirectly, through shared patients. New cancer management approaches could diffuse through such networks via social contagion, whereby ideas and behaviors spread through interconnected groups of people. It is particularly timely to explore new constructs that shape the delivery of cancer care, as the rapid diffusion of expensive, unproven, and sometimes ineffective cancer interventions poses a significant threat to the sustainability of the cancer car system and to the health of individual patients. For instance, the use of advanced imaging tests (AITs) such as PET scans and MRI for women with breast cancer has increased substantially over the past decade, despite little evidence supporting their use. Further, once an intervention has diffused into practice and become a standard of care, it can remain widely used even when there is evidence that it provides limited or no incremental benefit compared to less expensive or burdensome alternatives. For example, radiation oncologists have been reluctant to abandon the lengthier and more expensive "standard" courses of radiation for breast cancer, despite evidence that shorter courses yield similar outcomes. To address these concerns, we will focus on Medicare beneficiaries undergoing breast cancer care. We aim to (1) construct physician patient-sharing networks; (2) assess the impact of physicians and social contagion on the early adoption of AITs and the early abandonment of more costly and inconvenient longer-course radiotherapy; (3) identify physician and physician network characteristics associated with early adoption or abandonment of interventions; and (4) assess the population-level impact of physicians' adoption and abandonment of these interventions in terms of costs, care patterns, and outcomes, across physicians. Within any complex system, it is critical to understand factors that drive the behavior of individuals. A rigorous analysis of the complex web of physician and patient interactions in cancer care can not only provide a rich understanding of how physicians influence the behavior of their peers, but also identify a potentially powerful lever for inducing physicians to abandon ineffective interventions or discourage the use of unproven ones (Provocative Question E-3).

描述（由申请人提供）：将癌症护理与最佳医疗证据保持一致的努力主要集中在传播准则，增强医师与患者的沟通和修改支付模式。尽管这些是关键策略，但可能会忽略对医师行为的另一个主要影响 - 如果医师的同龄人的实践是她或他是否采用一种新的癌症干预或放弃另一个癌症的决定因素，该怎么办？我们提出了一项新的研究，对医生和医师分享网络对采用和放弃癌症干预措施的影响的影响。医师网络是通过共同患者直接或间接地相互合作的医师组。新的癌症管理方法可以通过社会传播通过此类网络扩散，从而通过相互联系的人群传播思想和行为。 探索塑造癌症护理提供的新结构是尤其及时的，因为昂贵，未经证实，有时无效的癌症干预措施的快速扩散对癌症汽车系统的可持续性和个别患者的健康构成了重大威胁。例如，在过去的十年中，使用先进的成像测试（AIT）（AIT），例如PET扫描和MRI，尽管很少有证据支持其使用，但在过去的十年中，使用了高级成像测试。此外，一旦干预逐渐扩散到实践中并成为护理标准，即使有证据表明，它与便宜或繁重的替代方案相比，它具有有限或没有增量的益处。例如，辐射肿瘤学家一直不愿放弃乳腺癌的较长，更昂贵的“标准”放射线课程，尽管有证据表明较短的课程产生了相似的结果。 为了解决这些问题，我们将专注于接受乳腺癌护理的医疗保险受益人。我们的目标是（1）构建医师分享网络； （2）评估医生和社会传染对早期采用AIT的影响以及早期遗弃更昂贵和不便的长期放射疗法； （3）确定与早期采用或放弃干预措施相关的医师和医师网络特征； （4）评估医师在整个医生的成本，护理模式和结果方面对医师采用和放弃这些干预措施的人口水平的影响。在任何复杂的系统中，了解推动个人行为的因素至关重要。对癌症护理中医师和患者相互作用的复杂网络的严格分析不仅可以使医生如何影响同龄人的行为有丰富的了解，而且还可以确定一个潜在的强大杠杆，以促使医生放弃无效的干预措施或劝阻使用未经证实的杠杆作用（挑衅性问题E-3）。