Barriers and enablers to the implementation of protocol-based imaging in pancreatic cancer

A qualitative study using the theoretical domains framework

Journal article (2020)

Authors

A.D. Maharaj Monash University
Sue M. Evans Cancer Council Victoria, Monash University
James G. Kench Royal Prince Alfred Hospital
Neil D. Merrett Western Sydney University
Rachel E. Neale Queensland Institute of Medical Research
Kate White University of Sydney
Peter Evans Peninsula Health
Trevor Leong University of Melbourne, Peter Maccallum Cancer Centre
Sally E. Green Monash University
John R. Zalcberg Alfred Health, Monash University
Liane J. Ioannou Monash University
Marnie Graco Alfred Health
Daniel Croagh Monash Health
Charles H.C. Pilgrim Alfred Health
Theresa Dodson Monash Health
David Goldstein University of New South Wales Faculty of Medicine
Jennifer Philip St. Vincent's Hospital and University of Melbourne, University of Melbourne
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Published Date

2020

Language

English

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Abstract

Background Accurate pre-operative imaging plays a vital role in patient selection for surgery and in allocating stage-appropriate therapies to patients diagnosed with pancreatic cancer (PC). This study aims to: (1) understand the current diagnosis and staging practices for PC; and (2) explore the factors (barriers and enablers) that influence the use of a pancreatic protocol computed tomography (PPCT) or magnetic resonance imaging (MRI) to confirm diagnosis and/or accurately stage PC. Methods Semi-structured interviews were conducted with radiologists, surgeons, gastroenterologists, medical and radiation oncologists from the states of New South Wales (NSW) and Victoria, Australia. Interviews were conducted either in person or via video conferencing. All interviews were recorded, transcribed verbatim, de-identified and data were thematically coded according to the 12 domains explored within the Theoretical Domains Framework (TDF). Common belief statements were generated to compare the variation between participant responses. Findings In total, 21 clinicians (5 radiologists, 10 surgeons, 2 gastroenterologists, 4 medical and radiation oncologists) were interviewed over a four-month-period. Belief statements relevant to the TDF domains were generated. Across the 11 relevant domains, 20 themes and 30 specific beliefs were identified. All TDF domains, with the exception of social influences were identified by participants as relevant to protocol-based imaging using either a PPCT or MRI, with the domains of knowledge, skills and environmental context and resources being offered by most participants as being relevant in influencing their decisions. Conclusions To maximise outcomes and personalise therapy it is imperative that diagnosis and staging investigations using the most appropriate imaging modalities are conducted in a timely, efficient and effective manner. The results provide an understanding of specialists' opinion and behaviour in relation to a PPCT or MRI and should be used to inform the design of future interventions to improve compliance with this practice.