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The Effect of Race and Decision Aids on Physician Recommendation for Prostate Cancer Treatment Planning
E396
International Journal of Radiation Oncology Biology Physics
nervous system modifying agents, 26% are pain medications, and 11% are hormone therapies. Conclusion: Our analysis suggests that radiation oncologist prescriptions constitute a relatively small proportion of Part D expenditures. The medications most commonly prescribed by radiation oncologists are typically used for symptomatic relief or hormone therapy. A large proportion of the most commonly prescribed and most costly drugs are used in the treatment of prostate cancer. Future studies should focus on determinants of variation in prescribing habits as well as economic and outcome implications. Author Disclosure: S. Maroongroge: None. K.B. Roberts: None. J.B. Yu: Research Grant; 21st Century Oncology.
there was a difference between the mean value for attendings vs students and attendings vs residents). Conclusion: Physicians were more likely to initially recommend ART to black men compared to white men, and this difference was not changed by the VF. Clinical experience may mitigate the impact of the VF on decision making. Author Disclosure: A. Mahal: None. B.A. Mahal: None. R. Singh: None. A.R. Green: None. P.L. Nguyen: Consultant; Ferring. J.B. Yu: Research funding to institution; 21st Century Oncology.
2976 The Effect of Race and Decision Aids on Physician Recommendation for Prostate Cancer Treatment Planning A. Mahal,1 B.A. Mahal,2 R. Singh,3 A.R. Green,4 P.L. Nguyen,5 and J.B. Yu6; 1Yale School of Medicine, New Haven, CT, 2Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, 3 Cleveland Clinic, Weston, FL, 4The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 5 Brigham & Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, 6Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT Purpose/Objective(s): Health disparities in medicine due to unconscious racial bias have been well documented. Recently, ASCO proposed a Value Framework (VF) to assist in decision making. We conducted a randomized survey to assess the impact of a VF on racial bias for caregivers of different stages in medical education and training. Materials/Methods: A secure, anonymous internet based survey with a hypothetical clinical vignette of an elderly man with pT3bN0M0 Gleason 4+3 Z 7 prostate cancer was emailed to 523 medical students at a single institute and 410 radiation oncologists at multiple institutes. Participants were randomly assigned a white or black patient vignette to assess racial bias followed by the same race vignette to assess use of a VF (based on SWOG 8794) in treatment planning. After viewing each vignette, pre- and post-VF, participants were asked if they would treat the patient with adjuvant radiation therapy (ART) or observation (OBS). Pearson’s Chisquared test and ANOVA were used to test hypotheses about relationships between patient race, medical training level, treatment recommendation, and attitude toward VF. All analysis was done using R Statistical software v 2.14.2. Results: Responses from 121 medical students, 43 residents, and 45 attendings were recorded. Overall response rate was 22.5%. Medical students randomized to the black patient vignette were at first more likely to recommend ART than medical students randomized to the white patient vignette (47.54% vs. 36.67%). After exposure to the VF, the difference in ART recommendation by medical students was reduced from 10.9% to 1.1%. These differences, however, were not statistically significant. In contrast, though physicians randomized to the black patient were also initially more likely to choose ART than those randomized to the white patient, the difference in treatment recommendation (favoring more ART for black patients) remained post-VF (P Z 0.018). Our findings also indicated that attendings are significantly less enthusiastic to use the VF in the future than both medical students and residents (one-way ANOVA, P Z 0.00; post-hoc pairwise comparisons found that at 95% significance
2977 International Health Care Transformation Through Web-Based Education P.H. Hardenbergh,1,2 B. Gehl,3 B.D. Kavanagh,4 and C.M. Fisher5; 1Shaw Regional Cancer Center, Edwards, CO, 2University of Colorado, Denver, CO, 3University of Rochester, Rochester, NY, 4Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, 5Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO Purpose/Objective(s): To improve the quality of cancer care by connecting radiation oncologists worldwide with highly specialized, disease site-specific experts. Materials/Methods: Chartrounds.com is a HIPPA-compliant website that allows community radiation oncologists and medical physicists to access real-time live presentation of cases and discussions with technical and disease site-specific experts via the internet on a scheduled basis. Each session is hosted in English, is free for participants and is disease sitespecific. At the conclusion of each one-hour session member-participants are asked to answer 6 feedback questions about their practice. Results: For the past 5 years 1,465 physicians and 254 medical physicists have registered as members of Chartrounds.com. Among these are 98 physician members and 14 medical physicists from 33 countries outside the US. The countries with the greatest international participation are India, Canada, and Egypt. The disease site-specific expert hosts are from 38 US academic medical centers. They have hosted 690 Chartround sessions to date. Seventy percent of all members practice in a communitybased hospital. Of 4,442 feedback responses, on a scale of 1 to 5, with 5 representing the greatest impact the mean response to feedback questions is as follows: Rate the quality of your session: 4.7, Were your goals of patient care met: 4.6, Was the session able to support your opinions: 4.6, Were discussions relevant to your daily practice: 4.6, Was your time used effectively during the session: 4.6, Was the session likely to impact a change in clinical practice: 3.9. These responses were similar for both US and international participants with the exception that international members were less likely to make a change in their practice as a result of the session 3.2 vs 3.9, P<0.05. Conclusion: Peer education and review is applicable to an international population of radiation oncologists and medical physicists through webbased technology. The majority of participants anticipate making changes to their clinical practice as a result of interacting with peers and specialists. These changes in practice result in improvements in the quality of oncology practiced world-wide. Further investigation into the motivation to enact change among international participants will seek to identify differences due to cultural influences, resource limitations, or other causes. This work was supported by the Improving Cancer Care Grant from the ASCO Conquer Cancer Foundation funded by Susan G Komen for the Cure, and the University of Colorado, Department of Radiation Oncology. Author Disclosure: P.H. Hardenbergh: Voting member; ASTRO. Founder and Chief; Chartrounds, LLC. B. Gehl: None. B.D. Kavanagh: Leadership; ASTRO. C.M. Fisher: None.
Abstract 2976; Table 1. n Medical Students Residents Attendings
White ART
Post-VF White ART
n
Black ART
Post-VF Black ART
60 36.67%
31.67%
61 47.54%
32.79%
20 40% 24 54.17%
35% 54.17%
23 65.22% 21 66.67%
69.57% 71.43%
2978 Health Care Expenditures Associated With the Management of Multiple Brain Metastases J.A. Miller,1 R. Kotecha,2 A.M. Mohammadi,3 E.S. Murphy,4 J.H. Suh,4 G.H. Barnett,2 M.A. Vogelbaum,5 L. Angelov,3 M. Ahluwalia,6 and S.T. Chao4; 1Cleveland Clinic Lerner College of Medicine of Case
International Journal of Radiation Oncology Biology Physics
nervous system modifying agents, 26% are pain medications, and 11% are hormone therapies. Conclusion: Our analysis suggests that radiation oncologist prescriptions constitute a relatively small proportion of Part D expenditures. The medications most commonly prescribed by radiation oncologists are typically used for symptomatic relief or hormone therapy. A large proportion of the most commonly prescribed and most costly drugs are used in the treatment of prostate cancer. Future studies should focus on determinants of variation in prescribing habits as well as economic and outcome implications. Author Disclosure: S. Maroongroge: None. K.B. Roberts: None. J.B. Yu: Research Grant; 21st Century Oncology.
there was a difference between the mean value for attendings vs students and attendings vs residents). Conclusion: Physicians were more likely to initially recommend ART to black men compared to white men, and this difference was not changed by the VF. Clinical experience may mitigate the impact of the VF on decision making. Author Disclosure: A. Mahal: None. B.A. Mahal: None. R. Singh: None. A.R. Green: None. P.L. Nguyen: Consultant; Ferring. J.B. Yu: Research funding to institution; 21st Century Oncology.
2976 The Effect of Race and Decision Aids on Physician Recommendation for Prostate Cancer Treatment Planning A. Mahal,1 B.A. Mahal,2 R. Singh,3 A.R. Green,4 P.L. Nguyen,5 and J.B. Yu6; 1Yale School of Medicine, New Haven, CT, 2Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, 3 Cleveland Clinic, Weston, FL, 4The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 5 Brigham & Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, 6Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT Purpose/Objective(s): Health disparities in medicine due to unconscious racial bias have been well documented. Recently, ASCO proposed a Value Framework (VF) to assist in decision making. We conducted a randomized survey to assess the impact of a VF on racial bias for caregivers of different stages in medical education and training. Materials/Methods: A secure, anonymous internet based survey with a hypothetical clinical vignette of an elderly man with pT3bN0M0 Gleason 4+3 Z 7 prostate cancer was emailed to 523 medical students at a single institute and 410 radiation oncologists at multiple institutes. Participants were randomly assigned a white or black patient vignette to assess racial bias followed by the same race vignette to assess use of a VF (based on SWOG 8794) in treatment planning. After viewing each vignette, pre- and post-VF, participants were asked if they would treat the patient with adjuvant radiation therapy (ART) or observation (OBS). Pearson’s Chisquared test and ANOVA were used to test hypotheses about relationships between patient race, medical training level, treatment recommendation, and attitude toward VF. All analysis was done using R Statistical software v 2.14.2. Results: Responses from 121 medical students, 43 residents, and 45 attendings were recorded. Overall response rate was 22.5%. Medical students randomized to the black patient vignette were at first more likely to recommend ART than medical students randomized to the white patient vignette (47.54% vs. 36.67%). After exposure to the VF, the difference in ART recommendation by medical students was reduced from 10.9% to 1.1%. These differences, however, were not statistically significant. In contrast, though physicians randomized to the black patient were also initially more likely to choose ART than those randomized to the white patient, the difference in treatment recommendation (favoring more ART for black patients) remained post-VF (P Z 0.018). Our findings also indicated that attendings are significantly less enthusiastic to use the VF in the future than both medical students and residents (one-way ANOVA, P Z 0.00; post-hoc pairwise comparisons found that at 95% significance
2977 International Health Care Transformation Through Web-Based Education P.H. Hardenbergh,1,2 B. Gehl,3 B.D. Kavanagh,4 and C.M. Fisher5; 1Shaw Regional Cancer Center, Edwards, CO, 2University of Colorado, Denver, CO, 3University of Rochester, Rochester, NY, 4Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, 5Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO Purpose/Objective(s): To improve the quality of cancer care by connecting radiation oncologists worldwide with highly specialized, disease site-specific experts. Materials/Methods: Chartrounds.com is a HIPPA-compliant website that allows community radiation oncologists and medical physicists to access real-time live presentation of cases and discussions with technical and disease site-specific experts via the internet on a scheduled basis. Each session is hosted in English, is free for participants and is disease sitespecific. At the conclusion of each one-hour session member-participants are asked to answer 6 feedback questions about their practice. Results: For the past 5 years 1,465 physicians and 254 medical physicists have registered as members of Chartrounds.com. Among these are 98 physician members and 14 medical physicists from 33 countries outside the US. The countries with the greatest international participation are India, Canada, and Egypt. The disease site-specific expert hosts are from 38 US academic medical centers. They have hosted 690 Chartround sessions to date. Seventy percent of all members practice in a communitybased hospital. Of 4,442 feedback responses, on a scale of 1 to 5, with 5 representing the greatest impact the mean response to feedback questions is as follows: Rate the quality of your session: 4.7, Were your goals of patient care met: 4.6, Was the session able to support your opinions: 4.6, Were discussions relevant to your daily practice: 4.6, Was your time used effectively during the session: 4.6, Was the session likely to impact a change in clinical practice: 3.9. These responses were similar for both US and international participants with the exception that international members were less likely to make a change in their practice as a result of the session 3.2 vs 3.9, P<0.05. Conclusion: Peer education and review is applicable to an international population of radiation oncologists and medical physicists through webbased technology. The majority of participants anticipate making changes to their clinical practice as a result of interacting with peers and specialists. These changes in practice result in improvements in the quality of oncology practiced world-wide. Further investigation into the motivation to enact change among international participants will seek to identify differences due to cultural influences, resource limitations, or other causes. This work was supported by the Improving Cancer Care Grant from the ASCO Conquer Cancer Foundation funded by Susan G Komen for the Cure, and the University of Colorado, Department of Radiation Oncology. Author Disclosure: P.H. Hardenbergh: Voting member; ASTRO. Founder and Chief; Chartrounds, LLC. B. Gehl: None. B.D. Kavanagh: Leadership; ASTRO. C.M. Fisher: None.
Abstract 2976; Table 1. n Medical Students Residents Attendings
White ART
Post-VF White ART
n
Black ART
Post-VF Black ART
60 36.67%
31.67%
61 47.54%
32.79%
20 40% 24 54.17%
35% 54.17%
23 65.22% 21 66.67%
69.57% 71.43%
2978 Health Care Expenditures Associated With the Management of Multiple Brain Metastases J.A. Miller,1 R. Kotecha,2 A.M. Mohammadi,3 E.S. Murphy,4 J.H. Suh,4 G.H. Barnett,2 M.A. Vogelbaum,5 L. Angelov,3 M. Ahluwalia,6 and S.T. Chao4; 1Cleveland Clinic Lerner College of Medicine of Case