title: Differences between pulmonologists, thoracic surgeons and radiation oncologists in deciding on the treatment of stage I non-small cell lung cancer: A binary choice experiment.
abstract: OBJECTIVE
  Surgery is the standard of care in stage I non-small cell lung cancer (NSCLC), but stereotactic ablative radiotherapy (SABR) is increasingly used to treat patients at high-risk for surgical complications. We studied which patient- and clinician-related characteristics influenced treatment recommendations.
  
  
  METHODS
  A binary choice experiment with hypothetical cases was conducted. Cases varied on five patient-related characteristics: patient age, Chronic Obstructive Pulmonary Disease Global Initiative for Chronic Obstructive Lung Disease (COPD GOLD) score, Charlson co-morbidity index, World Health Organization performance status (WHO-PS) and patient treatment preference (surgery/SABR). Clinician characteristics were recorded. Responses were analyzed using generalized linear mixed models.
  
  
  RESULTS
  126 clinicians completed the survey. All patient-related characteristics, the clinician speciality, and whether clinicians considered outcomes of surgery comparable to SABR, significantly influenced treatment recommendations. Pulmonologists were most influenced by WHO-PS and comorbidity, whereas comorbidity and age had greatest influence on radiation oncologists and surgeons. Clinicians were less influenced by stated patient preference and COPD GOLD score. Limited consistency was observed in treatment recommendations.
  
  
  CONCLUSIONS
  This study suggests that more efforts are needed to develop uniform approaches for making treatment recommendations, and also to incorporate patient preferences when making treatment decisions for stage I NSCLC.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.hopmans@vumc.nl.
authors.forename: Wendy
authors.initials: W
authors.lastname: Hopmans
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Institute of Medical Education Research Rotterdam, Erasmus MC, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Zwaan
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ineke
authors.initials: I
authors.lastname: van der Wulp
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.affiliation: Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Hartemink
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000601:surgery; D015897:Comorbidity; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive
keywords: Non-small cell lung cancer; Practice variation; Stereotactic ablative radiotherapy; Surgery; Thoracic oncologists