Planning to implement high-quality active surveillance in new-onset favorable risk prostate cancer

Project Summary Many men with favorable-risk prostate cancer do not benefit from aggressive intervention. As a preferred alternative, active surveillance is increasingly used to spare men from the potentially significant morbidity of treatment. Although adoption of surveillance has increased over the last decade, its implementation varies widely. Surveillance requires identification of patients with indolent tumors, coupled with monitoring for changes in cancer severity. Unfortunately, insufficient monitoring can render surveillance dangerous by exposing men to morbidity, and potentially mortality, from avoidable cancer progression. Nearly all research related to surveillance quality has focused on patient selection as opposed to implementation. Confirmatory testing within 6 months of diagnosis, using prostate biopsy or MRI, is a key component to ensure appropriate selection, as nearly half of men harbor more aggressive disease, albeit undetected, and may be better suited for treatment. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative consisting of 90% of all urologists in the state of Michigan and is expanding outside the state. Among MUSIC urologists initiating surveillance, the use of confirmatory testing in men with favorable-risk prostate cancer is only 61%. As there is strong evidence that urologist and practice characteristics are associated with initiation of surveillance, there is good reason to believe that these factors are also associated with use of confirmatory testing and adherence to guidelines. The objective of this proposal is to design and develop implementation interventions aimed at improving the quality of surveillance, and plan a large-scale trial to test the implementation interventions with the following aims: 1) Assess the relative importance of key implementation determinants; 2) Design and tailor interventions to support implementation of quality surveillance in urology practices; and 3) Assess the value of including practice sites beyond the original MUSIC sites in Michigan in the planned R01.