Evidence map›Paper›PMID 38594740›Full record

ArticleImplementation science communications2024

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

Ted A Skolarus, Sarah T Hawley, Jane Forman, Anne E Sales, Jordan B Sparks, Tabitha Metreger, Jennifer Burns, Megan V Caram, Archana Radhakrishnan, Lesly A Dossett and 12 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03579680 (De-implementation of Low Value Castration for Men With Prostate Cancer), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.3field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03579680 nacompletednot on this map

De-implementation of Low Value Castration for Men With Prostate Cancer

TypeinterventionalSponsorUniversity of MichiganRan2018 to 2023Enrolled60ConditionsCancer of ProstateArmsADT ORDER CHECK ATTESTATION (OR), PROVIDER SCRIPT (SC)
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 9 institutions in 2 countries.

Ted A SkolarusVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. tskolarus@bsd.uchicago.edu.
Sarah T HawleyVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Jane FormanVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Anne E SalesVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Jordan B SparksVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Tabitha MetregerVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Jennifer BurnsVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Megan V CaramVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Archana RadhakrishnanDepartment of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Lesly A DossettDepartment of Surgery, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
Danil V MakarovVA New York Harbor Healthcare System and NYU School of Medicine Departments of Urology and Population Health, New York, NY, USA.
John T LeppertSurgical Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Jeremy B SheltonVA Salt Lake City Healthcare System, Salt Lake City, UT, USA.
Kristian D StenslandDepartment of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA.
Jennifer DunsmoreAcademic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK.
Steven MaclennanAcademic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK.
Sameer SainiVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Brent K HollenbeckDepartment of Urology, Massachusetts General Hospital, Boston, MI, USA.
Vahakn ShahinianDepartment of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA.
Daniela A WittmannDepartment of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA.
Varad DeolankarRoss School of Business, University of Michigan, Ann Arbor, MI, USA.
S SriramRoss School of Business, University of Michigan, Ann Arbor, MI, USA.
VA Ann Arbor Healthcare System · USUniversity of Michigan · USUniversity of Aberdeen · GBMassachusetts General Hospital · USRoss School · USStanford University · USUniversity of Chicago · USVA NY Harbor Healthcare System · USVA Salt Lake City Healthcare System · US

Funding

De-implementation of low value castration for men with prostate cancerR37CA222885 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI SAINI, SAMEER DEV, SKOLARUS, TED ALBERT · 2018 to 2023
$3.6M
NCI NIH HHS R37 CA222885
6 · The paper itself

Abstract

backgroundMany 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.

methodsOur 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.

resultsOur 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.

conclusionsOur 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 registrationClinicalTrials.gov, NCT03579680.

Indexed as

ADT Prostate cancerBehavioral theoryBehavior changeComplex health interventionsDe-implementationDiscrete choice experimentImplementationInterventionLow-valueTheoretical domains framework

Identifiers

PMID38594740
PMCPMC11005280
OpenAlexW4394606298

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.