Abstract
Recently, there has been increasing interest in methodological aspects of advanced imaging, including the role of guidelines, recommendations, and experts’ consensus, the practice of self-referral, and the risk of diagnostic procedure overuse. In a recent Delphi study of the European Association for Nuclear Medicine (EANM), panelists were asked to give their opinion on 47 scientific questions about imaging in prostate cancer. Nine additional questions exploring the experts’ attitudes and opinions relating to the procedure of consensus building itself were also included. The purpose was to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts’ point of view. Results: Regarding the factors likely to influence the willingness to refer a patient for imaging, the most voted were incorporation into guidelines and data from scientific literature, while personal experience and personal relationship were chosen by a small minority. Regarding the recommendations more relevant to prescribe an imaging procedure, it resulted the incorporation into guidelines promoted by scientific societies (59% of votes); these guidelines also resulted the more trusted. With respect to patients’ preferences considered when prescribing an imaging procedure, the most voted was accuracy, resulted more important than easy access and time to access to the procedure. The majority of the experts expressed the opinion that there is a scarce use of imaging procedures in prostate cancer. With respect to the most relevant factor to build consensus, it resulted the transparency of the process (52% of votes), followed by multidisciplinarity of contributors. The main obstacle to incorporation of modern imaging procedures into guidelines resulted the lack of primary literature on clinical impact. Conclusions: Firstly, the panelists portray themselves as having Evidence-Based Medicine oriented and scientifically inclined attitudes and preferences. Secondly, guidelines and recommendations from scientific societies, especially clinical ones, are positively taken into account as factors influencing decisions, but panelists tend to consider their own appraisal of the scientific literature as more relevant. Thirdly, in respect of overuse, panelists do not think that advanced diagnostic procedures are overutilized in the specific case of Prostate Cancer, but rather they are underutilized.
Highlights
Production of clinical practice guidelines and consensus statements is of paramount importance for the medical community
Our goal is to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts’ point of view
Question number 48 was, “Which factors are likely to influence your willingness to refer a patient for an imaging procedure, assuming that availability is not limited?”, and panelists were asked to choose all that apply
Summary
Production of clinical practice guidelines (hereinafter “guidelines”) and consensus statements is of paramount importance for the medical community. Cancers 2019, 11, 1788 an increasing number of therapeutic and diagnostic options for many diseases requires careful choices, and evidence-based data such as meta-analyses are not always sufficient to drive appropriate use of medical options [1,2]. This is arguably more relevant in the field of advanced medical imaging, where the evaluation of a new diagnostic technique is often not obtainable from evidence cased on randomized controlled trials (RCT), for both conceptual and practical reasons [3]. It has recently been pointed out that scarce adherence to guidelines and recommendations favors self-referral and excessive compliance with patients’ requests, factors that may cause overuse of diagnostic procedures [10,11]. In addition to these problematic aspects, guidelines are likely to be affected by bias as they are promoted by professional organizations which may tend to select experts from among their members [12,13]
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