1. Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC).
- Author
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Cary, Clint, Yan Tong, Linsell, Susan, Ghani, Khurshid, Miller, David C., Weiner, Michael, Koch, Michael O., Perkins, Susan M., and Zimet, Gregory
- Subjects
ADJUVANT chemotherapy ,CANCER invasiveness ,UROLOGICAL surgery ,INTRAVESICAL administration ,CONJOINT analysis ,BLADDER cancer - Abstract
Purpose: National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy. Materials and Methods: Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order. Results: A total of 58 urologists answered the clinical vignettes which represents >75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility[8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility[4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in. Conclusions: This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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