Multiple Healthcare Professionals Research Articles

Approaches to Deprescribing Proton Pump Inhibitors in Clinical Practice: A Systematic Review.

Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven effectiveness, the implementation of deprescribing in clinical practice remains inconsistent and varied, making it challenging to identify the most effective strategies. The goal is to provide a comprehensive outline of deprescribing interventions for PPI therapy implemented across various settings and by different healthcare professionals. Methods: The study is designed to be a systematic review of the published literature. PubMed, Embase, and Web of Science databases were searched from 1 January 1989 (the first PPI on the market) to 30 September 2024 for articles assessing PPI deprescribing in adult patients, focusing on the implementation rate (primary outcome) or effects on symptoms (secondary outcome). Results: After screening, 66 studies were included, predominantly pragmatic trials (N = 32) or randomized controlled trials (N = 25). We found a variety of interventions promoting PPI deprescription. Collaborative efforts involving multiple healthcare professionals, the use of algorithms for clinical decision-making, and patient involvement have proven to be key elements in the most effective strategies. Discontinuing therapy may not be advisable in cases of recurrent symptoms, suggesting that on-demand therapy could be a recommended approach. Deprescribing is particularly relevant for individuals with mild illnesses and symptoms, where tapering can effectively mitigate the rebound symptoms often associated with abrupt discontinuation. Conclusions: Given the current prevalence of inappropriate PPI prescribing, it is imperative to raise awareness among both physicians and patients about the importance of the deprescribing process, which should be tailored to the specific needs of each patient, considering his/her medical history, current health status, and personal preferences.

Stakeholders’ perspective on the development of a virtual clinic for patients with spinal cord injury: a qualitative study

Purpose This study aims to explore the priorities, preferences, and feedback of multiple healthcare professionals to inform the future development of virtual clinics for community-dwelling adults with spinal cord injury (SCI) in Ontario, Canada. Methods Interpretive description methodology was used to guide our exploration. Semi-structured interviews were conducted with 15 expert healthcare professionals (HCPs) involved in the care of patients with SCI. Interviews were recorded and transcribed verbatim. Interview transcripts were then analyzed using a six-phase thematic analysis approach. Results HCPs perceived virtual care to improve access to care over the long term, particularly to those living in rural areas, as well as increase connections between different providers. However, participants highlighted that in-person care is still required for management of severe SCI-related sequelae that can be life-threatening, such as pressure ulcers, spasticity, respiratory issues, and bowel and bladder complications. Conclusion Our findings can be used to inform policymakers, HCPs, and stakeholders involved with SCI rehabilitation when establishing a virtual clinic for patients with SCI. Results of this study found that policymakers and HCPs should consider hybridized (blend of virtual and in-person) healthcare and uptake of multidisciplinary approaches within the virtual healthcare systems.

Development of a Concourse for Two Q-Method Studies Exploring Perspectives of Patients with Multiple Sclerosis and Healthcare Professionals on the Use of Wearable Technology-Lessons Learnt.

This paper presents the generation of a Q-set for two Q studies investigating the perspectives of (1) patients with multiple sclerosis and (2) their healthcare professionals on the use of wearable technology. It describes the adopted Q methodology and how it was applied in different phases. The concourse is derived from the relevant literature, based on the unified theory of acceptance and use of technology (UTAUT2) model, with privacy as a moderator, and Hofstede's "Cultural Dimensions" framework, incorporates statements drawn from the concourse following review by experts This is followed by a pilot study involving 4 stakeholders to improve the relevance and quality of the research. A 43-statement Q-sample was developed for the first Q study, and a 32-statement Q-sample was developed for the second Q study. This preliminary study reported the development of a legitimate and reliable concourse in a transparent and comprehensive manner. The lessons learnt from developing the concourse in this study could be beneficial for future research when conducted in a similar digital healthcare context and in the context of MS where individuals often experience symptoms related to vision, sensation, coordination, and movement.

Experiences with a national team-based learning program for advance care planning in pediatric palliative care

BackgroundAdvance Care Planning (ACP) enables patients and relatives to define and share values, goals and preferences for future medical treatment and care. The IMplementing Pediatric Advance Care Planning Toolkit (IMPACT), developed in the Netherlands, is a method for conducting ACP in pediatric palliative care. Healthcare professionals who were trained to use IMPACT, indicated their need for ongoing support to practice ACP communication skills optimally over time. Therefore, we developed a team-based learning program aimed at teaching participants how to transfer knowledge on ACP, continue practicing ACP communication skills and reflect on ACP conversations within their own team context. The aim of this study was to evaluate the program’s transfer of knowledge as well as the professionals’ experience and team reflection on ACP.MethodsA one-day IMPACT train-the-trainer course was developed and a selection of healthcare professionals (facilitators) from pediatric palliative care teams (PPCTs) from all seven Dutch university hospitals and the specialized Center for Pediatric Oncology were invited to participate. Hereafter, facilitators were asked to transfer their course-acquired knowledge to their team members (learners) by organizing two coaching-on-the-job sessions. A mixed-methods design, combining questionnaires and field notes, was used to evaluate the level of knowledge transfer and team reflection achieved.ResultsEighteen healthcare professionals in the role of facilitator participated in the train-the-trainer course. In seven PPCTs one (n = 3) or two (n = 4) coaching-on-the-job session(s) took place, attended by 29 and 17 learners, respectively. In the questionnaires, 11 facilitators indicated that they had to some extent transferred acquired knowledge to their team members as intended. Sixteen out of 21 learners who participated in at least one coaching-on-the-job session, reported (somewhat) increased self-confidence for conducting ACP conversations. The reported main strength of the program was practicing with/learning from colleagues whereas dealing with workload and variation in existing ACP skills within PPCTs need more attention.ConclusionsThe newly developed team-based learning program resulted in intended transfer of knowledge and methodical reflection on ACP in coaching-on-the-job sessions in most participating PPCTs. Planning coaching-on-the-job sessions regarding ACP in pediatric palliative care with multiple healthcare professionals is challenging and needs more emphasis in the training.

Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis.

Globally, only 13.8% of patients with hypertension have their blood pressure (BP) controlled. Trials testing interventions to overcome barriers to BP control have produced mixed results. Type of health care professional delivering the intervention may play an important role in intervention success. The goal of this meta-analysis is to determine which health care professionals are most effective at delivering BP reduction interventions. We searched Medline and Embase (until December 2023) for randomized controlled trials of interventions targeting barriers to hypertension control reporting who led intervention delivery. One hundred articles worldwide with 116 comparisons and 90 474 participants with hypertension were included. Trials were grouped by health care professional, and the effects of the intervention on systolic and diastolic BP were combined using random effects models and generalized estimating equations. Pharmacist-led interventions , community health worker-led interventions, and health educator-led interventions resulted in the greatest systolic BP reductions of -7.3 (95% CI, -9.1 to -5.6), -7.1 (95% CI, -10.8 to -3.4), and -5.2 (95% CI, -7.8 to -2.6) mm Hg, respectively. Interventions led by multiple health care professionals, nurses, and physicians also resulted in significant systolic BP reductions of -4.2 (95% CI, -6.1 to -2.4), -3.0 (95% CI, -4.2 to -1.9), and -2.4 (95% CI, -3.4 to -1.5) mm Hg, respectively. Similarly, the greatest diastolic BP reductions were -3.9 (95% CI, -5.2 to -2.5) mm Hg for pharmacist-led and -3.7 (95% CI, -6.6 to -0.8) mm Hg for community health worker-led interventions. In pairwise comparisons, pharmacist were significantly more effective than multiple health care professionals, nurses, and physicians at delivering interventions. Pharmacists and community health workers are most effective at leading BP intervention implementation and should be prioritized in future hypertension control efforts.

Strategies to address recruitment to a randomised trial of surgical and non-surgical treatment for cancer: results from a complex recruitment intervention within the Mesothelioma and Radical Surgery 2 (MARS 2) study

ObjectivesRecruiting to randomised trials is often challenging particularly when the intervention arms are markedly different. The Mesothelioma and Radical Surgery 2 randomised controlled trial (RCT) compared standard chemotherapy with or...

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey

ObjectiveDelineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care.DesignBased on the literature and experts’ insights, we identified a list...

Experiences and attitudes of task-shifting and task-sharing of physicians, nurses, and nursing assistants in hospitals: a qualitative systematic review protocol.

The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Studies published in English or Japanese from the time each database was established to the present will be considered for inclusion. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. PROSPERO CRD42023409612.

Ileoanal pouch revision and excision surgery in a newly established pouch center: requirements and costs for service provision.

Complications of ileoanal pouch surgery affecting function and quality of life may require surgical correction or pouch excision. The management of patients with pouch dysfunction requires a multidisciplinary approach and demand for service provision include multiple healthcare professionals and resources. The aim of this study is to present the service requirements, and surgical outcomes for redo pouch surgery and pouch excision, with cost analysis of the required resources. All patients undergoing surgery for revision or excision of the ileoanal pouch from June 2021 to May 2023 were prospectively included. Patient undergoing only diagnostic procedures, or perineal procedures were excluded. Outcomes within 30days of surgery were collected, including readmissions and re-operations. Cost analysis of all investigations, outpatient appointments and procedures prior to pouch revision or pouch excision was conducted. Twenty patients were included during the 24months study period: 13 underwent abdominal revisional pouch surgery, 7 had ileoanal pouch excision. 15 patients (75%) were tertiary referrals from other hospitals in the UK. The median interval between index IPAA surgery and revision was 113months. Three multidisciplinary clinical appointments, two imaging modalities, and at least one invasive day-surgery procedure were required for each patient prior to surgery. Expertise and infrastructure are needed for indication and peri-operative management of patients with pouch dysfunction requiring pouch revision or pouch excision. We estimated a starting cost of £22.605 ($29.589) for provision of pouch revision or excision surgery for investigations and treatments from referral to the pouch unit to surgery. This likely represents an underestimate as only accounts for procedures performed since referral with pouch dysfunction.

Caring for older adults with cancerin Canada: Views from healthcare providers and cancer care allies in the community.

Cancer is common and disproportionately impacts older adults. Moreover, cancer care of older adults is complex, and the current Canadian cancer care system struggles to address all of the dimensions. In this project, our goal was to understand the barriers and facilitators to caring for older adults with cancer from perspectives of healthcare professionals and cancer care allies, which included community groups, seniors' centers, and other community-based supports. In collaboration with a patient advisory board, we conducted focus groups and interviews with multiple local healthcare professionals and cancer care alliesin British Columbia, Canada. We used a descriptive qualitative approach and conducted a thematic analysis using NVivo software. A total of 71 participants of various disciplines and cancer care allies participated. They identified both individual and system-level barriers. Priority system-level barriers for older adults included space and staffing constraints and disconnections within healthcare systems, and between healthcare practitioners and cancer care allies. Individual-level barriers relate to the complex health states of older adults, caregiver/support person needs, and the needs of an increasingly diverse population where English may not be a first or preferable language. This study identified key barriers and facilitators that demonstrate aligned priorities among a diverse group of healthcare practitioners and cancer care allies. In conjunction with perspectives from patients and caregivers, these findings will inform future improvements in cancer care. Namely, we emphasize the importance of connections among health systems and community networks, given the outpatient nature of cancer care and the needs of older adults.

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

BackgroundMultiple long-term conditions—the co-existence of two or more chronic health conditions in an individual—present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals.MethodsWe undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings.ResultsOf 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care.ConclusionsQualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.

Clusters of medical specialities around patients with multimorbidity – employing fuzzy c-means clustering to explore multidisciplinary collaboration.

Background: The increasing prevalence of multimorbidity challenges hospital care organization. Hospital care is structured around medical specialties and focused on separate treatment of individual organ systems. Consequently, patients with multimorbidity visit multiple healthcare professionals and have high healthcare utilization with a risk of interactions and contradictory treatments if multidisciplinary coordination is absent. Organizational structures for multidisciplinary collaboration between medical specialists in case of multimorbidity are, however, limited. To facilitate multidisciplinary, coordinated care and to prevent or minimize adverse health outcomes, it might be useful to organize hospital care around specific patterns of multimorbidity or medical specialties. Therefore, we hypothesized that the use of cluster analysis and real clinical data could be helpful to unravel groups of medical specialties who are simultaneously involved in hospital care for patients with multimorbidity. 
 Method: We performed a cross-sectional cohort study and used retrospectively collected electronic health record (EHR) from a Dutch hospital in 2017. We extracted EHR data of 22,133 patients with multimorbidity aged ≥18 years who had received outpatient clinical care for two or more chronic and/ or oncological diagnosis. We used a fuzzy c-means clustering algorithm and explored the patients’ membership degree factors to each cluster to distinguish subgroups of patients with a specific pattern of involved medical specialties.
 Results: The mean age was 67.9 years (interquartile range (IQR):20.9), and 56.0% was female. We identified six clusters and 22 subgroups. The clusters were: 1. dermatology/ plastic surgery, 2. six specialties, 3. pulmonology, 4. internal medicine/ cardiology/ geriatrics, 5. neurology/ rehabilitation/ anesthesiology, and 6. internal medicine. Most patients had a full or dominant membership to one cluster only (11 subgroups) and the remaining subgroups were combinations of two clusters. The prevalence of specific diagnosis groups, patient characteristics and healthcare utilization seemed to differ between subgroups. For instance, patients of the subgroup with high involvement of internal medicine, cardiology and geriatrics; was characterized by cardiometabolic diseases. These patients had the highest average age (median:73 years, IQR:16.2), number of diagnoses (median:5, IQR:3), and number of outpatient visits (median:7, IQR:6). Patients of the subgroup with involvement of both the cardiologist and pulmonologist had lower number of diagnoses (median:3, IQR:1) and outpatient visits (median: 5:, IQR:4). This subgroup was mostly characterized by pulmonary and heart diseases, which can both represent with symptoms as dyspnea. Thus, the subgroups and their characteristics can provide clues about potential target populations that might benefit from (more) multidisciplinary collaboration, such as a formalization of a cardiometabolic or dyspnea outpatient clinic. 
 Conclusion: Our study shows that it is possible to use fuzzy c-means cluster analysis and real clinical data to identify clinically relevant clusters and subgroups of medical specialties simultaneously involved in hospital care for patients with multimorbidity. With this strategy hospitals, healthcare professionals, and data scientists can further analyze which of these subgroups are target populations with multimorbidity that might benefit from improved multidisciplinary collaboration or new models of care.

A qualitative exploration of interprofessional collaborative practice between genetic counselors and mental health providers.

Genetic counselors (GCs) typically provide short-term counseling and assess patient needs, including the need for ongoing psychosocial support. While some patients may benefit from a referral to a mental health provider (MHP), previous research identified barriers to this process due to patient characteristics, the GC work environment, and MHP availability. Adoption of interprofessional collaborative practice (IPCP), a model where multiple healthcare professionals from diverse training disciplines collaborate to deliver patient care, may mitigate these barriers. Evidence suggests that IPCP both increases patient satisfaction and reduces healthcare spending. Anecdotal evidence suggests that GCs and MHPs may use IPCP in select institutions, but there is limited research examining these relationships. This study aims to characterize the benefits, barriers, and limitations of current IPCP practice between GCs and MHPs. Six semi-structured interviews with GCs and MHPs were completed and analyzed thematically. Four themes emerged: (1) mental health concerns in GC sessions and GC scope of practice; (2) establishing and maintaining IPCP between GCs and MHPs; (3) benefits, barriers, and limitations of IPCP; and (4) next steps to develop future IPCP. The findings suggest that there are varying approaches to IPCP that are influenced by perceptions of provider scope of practice. IPCP may mitigate some previously described referral barriers related to logistics, and the availability of trusted MHPs with knowledge of a GCs specialty, thereby improving patient and provider satisfaction.

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

ObjectivePatients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims...

Summary of Research: Collaboration Between Healthcare Professionals and People with Multiple Sclerosis to Develop Communication Tools to Improve the Standard of Multiple Sclerosis Care.

This is a summary of a previously published paper: Joint Healthcare Professional and Patient Development of Communication Tools to Improve the Standard of MS Care. It describes a collaboration between people with multiple sclerosis (PwMS) and healthcare professionals (HCPs) to identify challenges in multiple sclerosis (MS) care and design tools to improve communication during consultations.

232 A scoping review of Interprofessional collaboration for people over 65 with dementia living in the community

Abstract Background Inter-Professional Collaboration (IPC) has gained prominence for current and future community-based dementia services, as they transition to integrated care. IPC aims to improve patient outcomes by coordinating care across multiple Healthcare Professionals (HCPs) and facilitating informed decision-making. This scoping review examined the nature and extent of evidence on IPC for People with Dementia (PwD) in community settings. Methods The methodology process was guided by the PRISMA-ScR checklist, which aligned with the research question. This involved reviewing eligibility criteria and information sources, establishing a search strategy using PICO, removing duplicates using EndNote, and screening articles in Rayann. The selected articles were then charted in a PRISMA flow chart, critically appraised using CCAT, and synthesised into a data extraction table to complete the process. After screening and evaluation, 15 articles were selected for the scoping review from an initial pool of 1,584 articles. Results Findings were grouped into two main themes: (1) IPC in Community Dementia Care: significance, team building, challenges and opportunities, the role of interprofessional education (IPE) and (2) Community Care Networks: barriers to implementing IPC and region-specific care models and guidelines. Conclusion The scoping review found that IPC in the community can provide high-quality care for PWD, resulting in earlier detection, disease management, and continuity of care. These benefits, however, are contingent upon effective communication, interprofessional coordination and local and national resources. Furthermore, a universal lack of standardised training for HCPs was identified as a key challenge in this. The review also discussed specific roles of IPC teams in dementia care, such as utilising other members of the team to address the shortage of physicians.

P08.05.A A LONGITUDINAL CASE STUDY OF PATIENTS' EXPERIENCES IN THE INITIAL PHASE OF A BRAIN CANCER PATHWAY - AIMING TO IMPROVE PATIENT CARE

Abstract BACKGROUND A brain cancer diagnosis is life-transforming and involves accelerated diagnostics and treatment and care involving multiple settings and healthcare professionals. Patients are confronted with an uncurable cancer disease but also face progressive neurological and cognitive deficits over time, adding to the uncertain and stressful situation. Knowledge of patients' experiences during their hospital stay in the initial diagnostic phase is sparse. This study aimed to explore patients' experiences at the hospital during the diagnostic workup, the brain surgery, and the post-operative period until discharge and to describe what matters to patients when diagnosed with a malignant brain tumour. MATERIAL AND METHODS We used a descriptive longitudinal single-case study design to produce in-depth, context-dependent knowledge and capture real-life situations in patients' day-to-day care experiences from admission to discharge across three different departments throughout the initial diagnostic phase. To explore patients' views directly in the actual situations unfolding in practice, we followed one patient at a time and did 180 hours of field observation and 16 semi-structured interviews. We analyzed field notes and interviews by applying systematic text condensation. RESULTS An overarching theme, "A fast transition", was identified, describing the patients' experiences in the two central themes; "From feeling fine to an unknown journey" and "Patient involvement determined by system factors". Within the two themes, six subthemes emerged from the data: Overwhelming uncertainty and fear, Putting life on hold, An unfamiliar dependency and Being unprepared and side-lined, The significance of close relatives, and Managing care needs and demands. CONCLUSION The results add to understanding patients' experiences during the initial diagnostic phase. While part of the findings are a fact of life for patients diagnosed with a brain tumour, others point to specific areas for improvement. Small changes in care delivery can enhance patient involvement by proactively informing patients about their care plan, ensuring the presence of relatives during information giving and identifying patients' care needs and preferences. Establishing a patient and public involvement group in 2023 will provide more knowledge gaps for future research.

P-455 Survey of multiple myeloma (MM) patients and healthcare professionals (HCPs) on the relevance of existing health quality-of-life (QoL) questionnaires (QoLQ) to real-world QoL issues of MM patients

P-455 Survey of multiple myeloma (MM) patients and healthcare professionals (HCPs) on the relevance of existing health quality-of-life (QoL) questionnaires (QoLQ) to real-world QoL issues of MM patients

Pharmacists' Perceptions of Physician-Pharmacist Collaboration-A 2022 Cross-Sectional Survey in Poland.

Patient-centered care requires close collaboration among multiple healthcare professionals, including physician-pharmacist collaboration (especially as a part of pharmaceutical care). This study aimed to assess pharmacists' perceptions of physician-pharmacist collaboration as well as to identify factors associated with the willingness to provide pharmaceutical care services in Poland. This questionnaire-based survey was carried out in 2022 among community pharmacists from one of the largest franchise chain pharmacy networks in Poland. Completed questionnaires were received from 635 community pharmacists (response rate of 47.9%). Almost all the pharmacists agreed with the statement that there is a need for physician-pharmacist collaboration (98.2%), and 94.8% declared that pharmacists can help physicians in patient care and pharmacotherapy. Most pharmacists (80%) believed that physicians were not aware of the competencies of pharmacists resulting from Polish law. Patient education (89.9%), detection of polypharmacy (88%), and detection of interactions between drugs and dietary supplements (85.7%) were the most common tasks in the field of pharmaceutical care that can be provided by a pharmacist. Females were more likely (p < 0.05) to declare the need for physician-pharmacist collaboration. Age and location of the pharmacy were the most important factors (p < 0.05) associated with pharmacists' attitudes toward physician-pharmacist collaboration.

Magnetic Resonance Imaging Evaluation of Bone Metastases Treated with Radiotherapy in Palliative Intent: A Multicenter Prospective Study on Clinical and Instrumental Evaluation Assessment Concordance (MARTE Study).

Metastasis to bone is a common occurrence among epithelial tumors, with a high incidence rate in the Western world. As a result, bone lesions are a significant burden on the healthcare system, with a high morbidity index. These injuries are often symptomatic and can lead to functional limitations, which in turn cause reduced mobility in patients. Additionally, they can lead to secondary complications such as pathological fractures, spinal cord compression, hypercalcemia, or bone marrow suppression. The treatment of bone metastases requires collaboration between multiple healthcare professionals, including oncologists, orthopedists, neurosurgeons, physiatrists, and radiotherapists. The primary objective of this study is to evaluate the correlation between two methods used to assess local control. Specifically, the study aims to determine if a reduction in the volume of bone lesions corresponds to better symptomatic control in the clinical management of patients, and vice versa. To achieve this objective, the study evaluates morphological criteria by comparing pre- and post-radiotherapy treatment imaging using MRI and RECIST 1.1 criteria. MRI without contrast is the preferred diagnostic imaging method, due to its excellent tolerance by patients, the absence of exposure to ionizing radiation, and the avoidance of paramagnetic contrast media side effects. This imaging modality allows for accurate assessment of bone lesions. One of the secondary objectives of this study is to identify potentially useful parameters that can distinguish patients into two classes: "good" and "poor" responders to treatment, as reported by previous studies in the literature. These parameters can be evaluated from the imaging examinations by analyzing morphological changes and radiomic features on different sequences, such as T1, STIR (short tau inversion recovery), and DWI-MRI (diffusion-weighted).