Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists - 18/04/17
Abstract |
Background |
The extent of variability in treatment suggestions for melanocytic lesions made by pathologists is unknown.
Objective |
We investigated how often pathologists rendered suggestions, reasons for providing suggestions, and concordance with national guidelines.
Methods |
We conducted a cross-sectional survey of pathologists. Data included physician characteristics, experience, and treatment recommendation practices.
Results |
Of 301 pathologists, 207 (69%) from 10 states (California, Connecticut, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, and Washington) enrolled. In all, 15% and 7% reported never and always including suggestions, respectively. Reasons for offering suggestions included improved care (79%), clarification (68%), and legal liability (39%). Reasons for not offering suggestions included referring physician preference (48%), lack of clinical information (44%), and expertise (29%). Training and caseload were associated with offering suggestions (P < .05). Physician suggestions were most consistent for mild/moderate dysplastic nevi and melanoma. For melanoma in situ, 18 (9%) and 32 (15%) pathologists made suggestions that undertreated or overtreated lesions based on National Comprehensive Cancer Network (NCCN) guidelines, respectively. For invasive melanoma, 14 (7%) pathologists made treatment suggestions that undertreated lesions based on NCCN guidelines.
Limitations |
Treatment suggestions were self-reported.
Conclusions |
Pathologists made recommendations ranging in consistency. These findings may inform efforts to reduce treatment variability and optimize patterns of care delivery for patients.
Le texte complet de cet article est disponible en PDF.Key words : atypical nevi, dermatopathology, dysplastic nevi, melanocytic lesions, melanoma, melanoma in situ, treatment
Abbreviations used : M-Path, MPATH-Dx, NCCN
Plan
Supported by the National Cancer Institute (R01 CA151306, KO5 CA104699). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health. |
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Disclosure: Dr Lott is an employee of Bayer HealthCare Pharmaceuticals, which had no involvement in this research. Drs Lee, Weinstock, Zhao, Knezevich, Elder, Barnhill, Piepkorn, Reisch, Carney, Onega, and Elmore, and Ms Peacock have no conflicts of interest to declare. |
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Reprints will not be available from the authors. |
Vol 76 - N° 1
P. 121-128 - janvier 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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