Systematic review of interventions that improve provider compliance to imaging guidelines for prostate cancer

Abstract

Introduction: Radiographic staging with bone scan or computed tomography is not indicated for men with low-risk prostate cancer. Physician compliance with these imaging recommendations has been widely variable, leading to inappropriate testing and increased costs. The purpose of this systematic review was to identify and learn from interventions associated with improved physician compliance to imaging guidelines for prostate cancer staging. Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PubMed was searched through January 2022 for the following medical subject headings (MeSH) terms: (‘Practice Patterns, Physicians' or ‘Guideline Adherence’ or ‘Unnecessary Procedures’ or ‘Quality Improvement’) and (‘Prostatic Neoplasms/diagnostic imaging’). Inclusion required discussion of an intervention for physician compliance to prostate cancer imaging guidelines and specific data describing associated outcomes. Publications focused on other malignancies or without this intervention, evaluation, or data, were excluded. Results: Of 82 papers screened, only five met inclusion criteria — representing 12 802 patients. Each focused on reducing unnecessary imaging and demonstrated statistically significant post-intervention improvement of physician compliance to imaging guidelines for staging prostate cancer. Four were multidimensional, with education, clinical champions, and performance feedback. One used the unidimensional intervention of an electronic medical record (EMR)-based clinical reminder order check (CROC). No studies used randomization or a control group. Conclusions: Post-intervention improvement in physician compliance to imaging guidelines for staging prostate cancer has been associated with EMR-based CROC and combination interventions using clinical champions, education, and feedback. This has been observed at individual institutions and larger organizations spanning a region or state.