One gentle “nudge” may be all it takes to start reducing the number of unnecessary bone scans ordered for asymptomatic men with low-risk prostate cancer, results of a recent quality improvement intervention suggest.
The rate of bone scans for low-risk patients at one Veterans Affairs (VA) hospital dropped from 86.5% (32/37) in the year prior to the intervention, compared with 65.5% (19/29; p=.043) in the year afterward, according to results of a quasi-experimental before-and-after study published as a research letter in Advances in Radiation Oncology (in press).
The intervention consisted of a single presentation at a tumor board meeting, followed by a short group discussion. Attendees at the meeting included the chiefs of radiation oncology and urology, the chair of the Cancer Committee, and resident physicians/physician assistants from both services.
“The whole thing probably lasted 15 minutes or so,” said Eric Ojerholm, MD, of the University of Pennsylvania and the Crescenz VA Medical Center, Philadelphia. “Everyone pretty quickly agreed that we could improve on our rates of bone scans.”
Of note, the presentation was specifically designed to include social comparisons and appeals to professional norms, two behavioral science concepts that, when combined, may have powerful effects in influencing physician behavior (JAMA 2016; 316:1151–2). For social comparison, attendees were shown current rates of bone scans from peer institutions in the United States, including VA hospitals; for appeals to norms, guidelines from various professional groups were reviewed.