title: Risk stratification, treatment selection, and transplant eligibility in multiple myeloma: a qualitative study of the perspectives and self-reported practices of oncologists.
abstract: BACKGROUND
  Since the early 2000s, treatment options for multiple myeloma have rapidly expanded, adding significant complexity to the management of this disease. To our knowledge, no systematic qualitative research on clinical decision-making in multiple myeloma has been published. We sought to characterize how physicians view and implement guidelines and incorporate novel approaches into patient care.
  
  
  METHODS
  We designed a semi-structured qualitative interview guide informed by literature review and an expert advisory panel. We conducted 60-minute interviews with a diverse sample of oncology physicians in the southeast United States. We used a constant comparative method to code and analyze interview transcripts. The research team and advisory panel discussed and validated emergent themes.
  
  
  RESULTS
  Participants were 13 oncologists representing 5 academic and 4 community practices. Academic physicians reported using formal risk-stratification schemas; community physicians typically did not. Physicians also described differences in eligibility criteria for transplantation; community physicians emphasized distance, social support, and psychosocial capacity in making decisions about transplantation referral; the academic physicians reported using more specific clinical criteria. All physicians reported using a maintenance strategy both for post-transplant and for transplant-ineligible patients; however, determining the timing of maintenance therapy initiation and the response were reported as challenging, as was recognition or definition of relapse, especially in terms of when treatment re-initiation is indicated.
  
  
  CONCLUSIONS
  Practices reported by both academic and community physicians suggest opportunities for interventions to improve patient care and outcomes through optimal multiple myeloma management and therapy selection. Community physicians in particular might benefit from targeted education interventions about risk stratification, transplant eligibility, and novel therapies.
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and; Duke Cancer Institute, Duke University School of Medicine, Durham, NC, U.S.A.
authors.forename: T W
authors.initials: TW
authors.lastname: LeBlanc
authors.affiliation: Opus Science, Annapolis, MD, U.S.A.
authors.forename: A
authors.initials: A
authors.lastname: Howson
authors.affiliation: Opus Science, Annapolis, MD, U.S.A.
authors.forename: W
authors.initials: W
authors.lastname: Turell
authors.affiliation: Opus Science, Annapolis, MD, U.S.A.
authors.forename: P
authors.initials: P
authors.lastname: Sheldon
authors.affiliation: Duke Cancer Institute, Duke University School of Medicine, Durham, NC, U.S.A.
authors.forename: S C
authors.initials: SC
authors.lastname: Locke
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and.
authors.forename: S A
authors.initials: SA
authors.lastname: Tuchman
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and.
authors.forename: C
authors.initials: C
authors.lastname: Gasparetto
authors.affiliation: Celgene Corporation, Summit, NJ, U.S.A.
authors.forename: S
authors.initials: S
authors.lastname: Kaura
authors.affiliation: Celgene Corporation, Summit, NJ, U.S.A.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Khan
authors.affiliation: Duke Cancer Institute, Duke University School of Medicine, Durham, NC, U.S.A.
authors.forename: A P
authors.initials: AP
authors.lastname: Abernethy
keywords: Multiple myeloma; qualitative research; risk stratification; treatment decision-making