# A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging

> **NIH VA I01** · VA NEW YORK HARBOR HLTHCARE/SYS/BROOKLYN · 2020 · —

## Abstract

Background: Almost half of Veterans with localized prostate cancer (the most common non-cutaneous
malignancy among US men) receive inappropriate, wasteful imaging. The VHA Blueprint for Excellence
prioritizes increasing operational effectiveness. Prior studies seeking to limit inappropriate imaging did not assess
barriers and achieved mixed results. Our team has explored the causes of guideline-discordant prostate cancer
imaging and found that 1) patients with newly diagnosed prostate cancer have little concern for radiographic
staging but rather focus on treatment, 2) physician trust imaging guidelines but are apt to follow their own intuition,
fear medico-legal consequences, and succumb to influence from colleagues who image frequently. In spite of
such discrepant v iews, most VHA physicians suggested or supported a large-scale effort to improve imaging use
across VHA.
Intervention: We propose a multi-site, stepped wedge, cluster-randomized trial to determine the effect of a
physician-focused behavioral intervention on VHA prostate cancer imaging use. The multi-level intervention,
developed according to the Theoretical Determinants Framework, combines traditional physician behavior
change methods with novel methods of communication and data collection. The intervention consists of three
components: 1) a system of audit and feedback to clinicians informing individual clinicians and their sites about
how their behavior compares to their peers’ and to published guidelines 2) a program of academic detailing with
the goal to educate providers about prostate cancer imaging, and 3) a CPRS Clinical Order Check for potentially
inappropriate imaging. The intervention will be introduced to 10 participating geographically-distributed study
sites.
Analysis Plan: We will assess imaging rates 6 months prior to the intervention and 3 months following the
intervention. The study’s specific aims seek to understand the effects of the intervention on 1) facility-level
prostate cancer imaging rates, 2) physician experience with and perceptions of the intervention and its
implementation, and 3) the costs of both implementing the intervention and affecting change in imaging use.
These aims will support a subsequent intervention to improve guideline-concordant imaging across VHA.
Experience gained through this project will be leveraged to improve guideline-concordant care and increase
operational effectiveness in other domains.
Importance: This project seeks to describe and analyze the implementation of a behavioral intervention to
improve prostate cancer care. This theory-based intervention builds on prior work identifying barriers to
guideline-concordant prostate cancer imaging in VHA (CDA 11-257) and addresses these at three levels:
individual (audit and feedback with VHA Cancer Care Cube data), facility (academic detailing) and system (CPRS
Order Check). The team will assess the intervention’s cost impact and providers’ experiences in preparation for a
subsequent ...

## Key facts

- **NIH application ID:** 9663813
- **Project number:** 5I01HX002038-02
- **Recipient organization:** VA NEW YORK HARBOR HLTHCARE/SYS/BROOKLYN
- **Principal Investigator:** DANIL V. MAKAROV
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-03-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9663813

## Citation

> US National Institutes of Health, RePORTER application 9663813, A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging (5I01HX002038-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9663813. Licensed CC0.

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