How to use clinical vignettes in hematology--a pilot survey in the context of chronic lymphocytic leukemia.
BACKGROUND
Case vignettes have been validated as an efficient tool for assessing the quality of clinical practices, and have been used in a variety of medical settings. However, their use in the field of hematology has not been tested.


OBJECTIVE
We undertook a study to pre-test seven case vignettes, and thereby to assess practice patterns and, when possible, guideline adherence in the treatment of chronic lymphocytic leukemia (CLL) by French hematologists.


RESULTS
Of the 64 hematologists who agreed to participate, 26 (41%) completed the vignettes. We found significant differences in the physicians' patterns of ordering further investigations among young and old patients in the same clinical context. This is not consistent with published guidelines. Moreover, the most striking differences concerned the physicians' interpretations of prognostic factors and the use of radiological testing before treatment. Modalities of treatment were variable across clinical situations, especially with regard to second-line treatments. Clinicians understood the vignettes well, except for those that dealt with stem cell transplantation.


CONCLUSIONS
This pilot study showed the feasibility of the use of case vignettes to assess the quality of clinical practice in CLL. The initial results identified deviations from the published guidelines. A large-scale European survey will commence in a few months.
Camps
Sandra M
SM
INSERM 9504, Centre d'Investigations Cliniques, Hôpital Saint Louis, AP-HP, Université Paris 7, Paris, France.
Chevret
Sylvie
S
Lévy
Vincent
V
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002869:Chromosome Aberrations; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006405:Hematology / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D010820:Physicians; D010865:Pilot Projects; D011379:Prognosis