Feedback from fellow physicians helped doctors do fewer unnecessary tests on newly diagnosed prostate cancer patients in a study aimed at improving health care quality and consistency.
Coaching on the most current guidelines led doctors to cut in half the number of expensive CT scans and bone scans they ordered for low-risk patients, sparing them costs and potential side effects.
"The study is a great example of a new solution for an old problem," said Dr. David C. Miller, the lead researcher and a urologist at the University of Michigan. "Physicians are at the heart of the solution."
The research, by a consortium of urological surgeons in several Midwestern states and Virginia, looked at the diagnostic practices of doctors treating 858 patients with early, middle-or late-stage prostate cancer.
To determine whether the cancer had spread, or metastasized, to other parts of the body, many doctors initially ordered CT scans or bone scans, even on patients whose early-stage cancers were unlikely to have spread.
At the study's outset, 31 percent of low- and medium-risk patients received CT scans and 28 percent got bone scans, looking for signs of metastasis.
Both tests expose a patient to radiation, which is itself a risk factor for cancer.
After getting feedback and training in professional guidelines that cover when such tests are warranted, the doctors seemed to take the lessons to heart. At the end of the 16-month study, they used CT scans on only 16 percent of low- or medium-risk patients and bone scans on only 13 percent of them.
"Engaging doctors on a one-to-one basis, and pairing it with data that shows them how they are doing, is an emerging technology for changing care," said Dr. Richard Hermann, director of the Center for Quality Assessment and Improvement in Mental Health at Tufts University, who was not involved in the study.
Evaluating how well doctors adhere to guidelines is a growing field, in part because professional groups put extensive research into developing nationally accepted standards based on the most current evidence, but the information doesn't always trickle down to practitioners.
"There is a gradual sweeping evolution in how information is gathered and analyzed," said Hermann. "There is a dissemination process of information that, unfortunately, is not very systematic."
Eliminating tests deemed unnecessary has multiple benefits, including cutting healthcare costs, and protecting patients from risks from the tests themselves.
In men with early-stage prostate cancer, for example, screening tests can create more stress for the patient by uncovering findings that require further testing, but turn out to be harmless.
There are many reasons doctors might not follow national guidelines when diagnosing or treating patients, Miller said. Some may not even be aware of the guidelines' recommendations.
"We were concerned that there might not have been uniform familiarity with the guidelines," said Miller.
In addition, physicians may be slow to change what they do in the clinic if they have been using the same methods for decades, before such guidelines existed or when they differed from today's standards.
"Doctors might have been practicing for many years and have gotten comfortable with giving these tests, and it might be different from the best possible thing," said Miller.
Overall, he says, the study, which is published in the Journal of Urology, demonstrates that positive change can come from within medical practice.
"It's a lot more meaningful for doctors to hear about changes in their behavior from their own peers than from an insurance agent or a policy maker," Miller said.