title: Barriers to physician adherence to evidence-based monitoring guidelines in chronic myelogenous leukemia.
abstract: OBJECTIVE
  Although monitoring of cytogenetic/molecular responses to therapy in chronic myelogenous leukemia (CML) facilitates superior outcomes, less than one half of CML patients are monitored using published evidence-based guidelines. Barriers to physician adherence with guidelines are unknown.
  
  
  METHODS
  An anonymous survey was mailed to 515 hematologist-oncologists in New Jersey and Indiana exploring attitudes toward monitoring guidelines.
  
  
  RESULTS
  Ninety-six physicians (19%) responded-89% in community practice, 83% with more than 10 years of experience, and 92% caring for CML patients. Eighty-four percent self-reported using CML monitoring guidelines, 14% were familiar with but did not adopt guidelines and 2% were unfamiliar. Eighty-four percent performed molecular monitoring quarterly as recommended; 6% did not perform molecular monitoring at all during the first year. Guidelines were considered evidence based by 98%, but only 54% strongly considered them easy to find; only 51% strongly felt they addressed all aspects of disease management. Patient resource barriers were a significant deterrent toward implementation with 30% citing high costs. Physician resources, including lack of time to search guidelines, limited use in one fifth. Despite 90% believing an online database helpful, between one third and one half did not feel that additional training, professional society endorsements, or availability of expert consultations would encourage use.
  
  
  CONCLUSIONS
  Significant barriers to adherence with evidence-based CML guidelines exist. Resource barriers, lack of familiarity and lack of agreement restrict adoption, but efforts to facilitate use are not desired. Multifaceted educational strategies, including automated computerized reminders at point of care, are needed to improve quality outcomes in CML.
authors.affiliation: John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN sgoldberg@hackensackumc.org.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldberg
authors.affiliation: John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN.
authors.forename: Luke P
authors.initials: LP
authors.lastname: Akard
authors.affiliation: John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dugan
authors.affiliation: John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN.
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.affiliation: John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; and Indiana Blood and Marrow Transplantation, St Francis Hospital and Health Centers, Indianapolis, IN.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
mesh_terms: D022126:Access to Information; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016903:Drug Monitoring / Q000592:standards / Q000639:trends; D019317:Evidence-Based Medicine / Q000592:standards / Q000639:trends; D019983:Guideline Adherence / Q000592:standards / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D007196:Indiana; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D055118:Medication Adherence; D025202:Molecular Diagnostic Techniques / Q000592:standards / Q000639:trends; D058990:Molecular Targeted Therapy; D009515:New Jersey; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents