Lung cancer patient follow-up - Motivation of thoracic surgeons

Study objectives: To analyze variation in beliefs that potentially motivate thoracic surgeons in the design of posttreatment surveillance strategies f or lung cancer patients and to examine the relationship between motivation and follow-up intensity, Design: International survey. Setting: Ambulatory care. Participants: All 3,700 members of the Society of Thoracic Surgeons were su rveyed to measure their follow-up practices during the 5-year period after treatment, physician beliefs, and variation in these beliefs. The relations hip between beliefs, as potentially motivating factors, and follow-up inten sity was also analyzed. Measurements and results: Age, General Thoracic Surgery Club membership, pe rcentage of practice that was noncardiac, South Central United States pract ice location, and overseas practice location were most frequently related t o beliefs that potentially motivate physicians in the design of surveillanc e strategies. When viewed independently of follow-up practice patterns, tho racic surgeons appear to be motivated by the desire to please patients, avo id malpractice suits, and improve patient quality of life. When viewed in r elation to self-reported follow-up, none of these motivating factors were c onsistently associated with follow-up intensity. Belief in curative treatme nt of recurrence and enhanced Likelihood of immediate palliative treatment leading to improved survival were the factors most frequently associated wi th variation in follow-up. Although the ability of the logistic and stepwis e regression models to predict test use and follow-up intensity was less th an optimal for TNM I stage I patients, predictive ability was substantially improved for TNM stage II and III patients by including earlier-stage prac tice patterns as an independent variable. Conclusions: Physician characteristics and beliefs predicted a less than ex pected amount of the variation in self-reported follow-up intensity by TNM stage when modelled without knowledge of follow-up practice for any other T NM stage, Discrepancies between self-reported and actual follow-up may be p artially responsible, although lack of surveillance guidelines is more like ly. The inclusion of barriers to follow-up may improve future models.