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Table 4 Differences in the three medical centers—illustrated by quotes

From: A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer

Themes  

Low rates of inappropriate imaging

Middle rates of inappropriate imaging

High rates of inappropriate imaging

Knowledge of guidelines

“Obviously everyone does things differently, but I’m … I take a very simplistic approach to it. Where I essentially follow the NCCN Guidelines.”

“I use them sometimes. Guidelines as a guideline but I tend to be more cautious, or shall we say more aggressive in terms of diagnostic testing.”

“I think as clinicians we can’t just follow a cookbook recipe.”

Intuition vs. guidelines

“When I look at something, be it a guideline or an article, I say mm – here’s absolute proof that getting that study doesn’t impact the outcome a bit, that is evidence.”

“So guidelines are just that they guide your care they don’t prescribe the care for you.”

“So I may be capturing a little bit more and exposing a few more people to imaging but that’s my internal guidelines.”

Colleagues’ imaging habits

“They’re doing things appropriately here but at other VA’s I’ve seen anyone with a diagnosis of prostate cancer will get a, a kneejerk bone scan and CT scan.”

“We have spoken with this particular individual [image avid colleague] but we found that this was his practice preference and he really wanted to stick with it although he understood what the guidelines were.”

“We’re all part of the referral process to him and so we all know what he feels is the next step [always obtain a CT scan].”

Tendency to question colleagues or discuss guidelines

“I think their answers would be very similar to mine. We all have a very similar practice pattern since we’re all practicing with the same university and VA. We try to follow, you know, guideline concordant care across all the different types of cancer we treat.”

“And so we’ve had a number of patients with Gleason 6 disease and somebody ordered a bone scan on them and now we have to figure out what these questionable areas of uptake mean. And we spend a lot of time trying to discuss these findings to figure out what to do with them.”

“We have a fellowship – a memorial trained oncology guy and to tell you the truth, to argue with him [about imaging practices] is pretty arrogant or discourteous.”