Individual physician practice variation in hematopoietic cell transplantation.
OBJECTIVE
Previous studies have evaluated practice variation in hematopoietic cell transplantation (HCT) among transplant centers and countries. There are no studies investigating individual physician practice variation in HCT.


METHODS
An international Internet-based survey of transplant physicians collected data on medical decisions made by adult and pediatric HCT physicians. Multivariable analyses identified practitioner and transplant center characteristics predictive of medical decision making.


RESULTS
Analysis of 526 assessable respondents showed a wide variation in management approaches to specific clinical scenarios. Pediatric and adult transplant physicians differed significantly in their management strategies for chronic myeloid leukemia, acute and chronic graft-versus-host disease, and choice of graft source for patients with aplastic anemia. Among adult transplant physicians, there was little agreement on the patient factors favoring reduced intensity conditioning or myeloablative conditioning.


CONCLUSIONS
These results emphasize the heterogeneity of worldwide transplant practices. Local preferences or biases likely result in similar patients being offered different transplant and treatment procedures. The degree of practice variation also highlights the need for clinical trials to clarify areas of controversy. Where clinical trials are not feasible, data from observational studies may be the best available evidence to guide practice.
Lee
Stephanie J
SJ
Division of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-290, Seattle, WA 98109, USA. sjlee@fhcrc.org
Joffe
Steven
S
Artz
Andrew S
AS
Champlin
Richard E
RE
Davies
Stella M
SM
Jagasia
Madan
M
Kernan
Nancy A
NA
Loberiza
Fausto R
FR
Soiffer
Robert J
RJ
Eapen
Mary
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001752:Blast Crisis / Q000601:surgery; D003657:Decision Making; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000601:surgery*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D018380:Hematopoietic Stem Cell Transplantation / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020407:Internet; D007938:Leukemia / Q000188:drug therapy / Q000601:surgery*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000601:surgery*; D015470:Leukemia, Myeloid, Acute / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery; D011787:Quality of Health Care; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents