Clinician-reported changes in octreotide prescribing for malignant bowel obstruction as a result of an adequately powered phase III study : a transnational, online survey

Article indépendant

CAMPBELL, Rachel | MCCAFFREY, Nikki | BROWN, Linda | AGAR, Meera R. | CLARK, Katherine | CURROW, David

BACKGROUND: Translating research evidence into clinical practice often has a long lag time. AIM: To determine the impact of a phase III randomised controlled trial on palliative care clinicians' self-reported practice change. DESIGN: Online survey about use of octreotide in managing inoperable malignant bowel obstruction due to cancer or its treatments distributed in November 2016, 2 years after the first publication of the study in a peer-reviewed journal. Demographic, self-reported practice and the reasons underpinning this were collected. Responses were aggregated to ‘practice modified’ or ‘practice not modified’. A multinomial regression model explored predictors of practice change. SETTING: Members of the Australian New Zealand Society of Palliative Medicine. RESULTS: Response rate was 20.8% (106/509): 55.6% were aged >50 years, 56.5% were female and 77% had previously prescribed octreotide for this clinical indication. Out of 106 respondents, 52 (49.1%) indicated modified practice (60.9% of those who had previously prescribed octreotide in this setting). In those who reported practice change, most frequently octreotide was now used when other therapies failed; for not changing practice, ‘more confirmatory evidence was needed’ was most often cited. In the regression model, older age (clinician age = 50–59 years; relative risk = 0.147; 95% confidence interval = 0.024–0.918; p = 0.04) and having practices with lower proportions of people treated with octreotide (0%–20%; relative risk = 0.039; 95% confidence interval = 0.002–0.768; p = 0.033) predicted greater self-reported practice change. CONCLUSION: Clinician-reported change in practice in the survey is seen in the majority of respondents. This suggests that there is a cohort of 'early adopters' within palliative care practice as new evidence becomes available.

http://dx.doi.org/10.1177/0269216318778460

Voir la revue «PALLIATIVE MEDICINE, 32»

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