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Decision to Adopt Medical Technology

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Listed:
  • Heather Taffet Gold
  • Kimberly Pitrelli
  • Mary Katherine Hayes
  • Madhuvanti Mahadeo Murphy

Abstract

Objective. To understand decision making concerning adoption and nonadoption of accelerated partial breast radiotherapy (RT) prior to long-term randomized trial evidence. Methods. A total of 36 radiation oncologists and surgeons were recruited through purposive and snowball sampling strategies from September 2010 through January 2013. Semistructured phone interviews were conducted and audio-recorded and lasted 20–45 minutes. Qualitative analysis was conducted using a framework approach, iteratively exploring key concepts and emerging issues raised by subjects. Interviews were transcribed and imported into Atlas.ti v6. Transcripts were independently coded by 3 researchers shortly after each interview, followed by consensus development on each coded transcript. Barriers and facilitators of adoption, practice patterns, and informational/educational sources concerning accelerated partial breast RT were all assessed to determine major themes. Results. Nearly half of physicians were surgeons (47%), and half were radiation oncologists (53%), with 61% overall in urban settings. Twenty-nine of the 36 physicians interviewed used brachytherapy-based partial breast RT. Five major factors were involved in physicians’ decisions to adopt accelerated partial breast RT: facilitators encouraging adoption (e.g., enthusiastic colleagues and patient convenience), financial and prestige incentives, pressures to adopt (e.g., potential declines in referrals), judgment concerning acceptable level of scientific evidence, and barriers (e.g., not having appropriate machinery or referral mechanism in place). If technology was adopted, clinical guideline adherence varied. Conclusions. Technology adoption is based on financial and social pressures, along with often-limited scientific evidence and what seems “best†for patients. For technology adoption and diffusion to be rational and evidence-based, we must encourage appropriate financial payment models to curb use outside of research studies and promote development of additional treatment registries until sufficient evidence is gathered.

Suggested Citation

  • Heather Taffet Gold & Kimberly Pitrelli & Mary Katherine Hayes & Madhuvanti Mahadeo Murphy, 2014. "Decision to Adopt Medical Technology," Medical Decision Making, , vol. 34(8), pages 1006-1015, November.
  • Handle: RePEc:sae:medema:v:34:y:2014:i:8:p:1006-1015
    DOI: 10.1177/0272989X14541679
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    References listed on IDEAS

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    1. Jonathan Skinner & Douglas Staiger, 2007. "Technology Adoption from Hybrid Corn to Beta-Blockers," NBER Chapters, in: Hard-to-Measure Goods and Services: Essays in Honor of Zvi Griliches, pages 545-570, National Bureau of Economic Research, Inc.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
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    Cited by:

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    2. Cathy J. Bradley & David Neumark & Lauryn Saxe Walker, 2017. "The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial," NBER Working Papers 24100, National Bureau of Economic Research, Inc.
    3. Bradley, Cathy J. & Neumark, David & Walker, Lauryn Saxe, 2018. "The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia," Journal of Health Economics, Elsevier, vol. 62(C), pages 121-133.

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