Entering an Era of Patient Engagement in Imaging Research

This post was contributed by Ruth Carlos, MD, FACR, project lead of “Defining a Roadmap of Patient Engagement in Imaging CER” and a professor of radiology, division of abdominal radiology, University of Michigan Health Services.

Carlos_RuthOnce limited to serving as research subjects and observers, patients and their advocates can now engage with imaging researchers in the planning, execution and analysis of clinical trials.

The ECOG-ACRIN Cancer Research Group leads in a new paradigm for imaging comparative effectiveness research (CER) where researchers engage with patients and patient advocates at every step of the process.

CER results are most valuable when relevant to clinical investigators and patient communities. Our preparation for the “Defining a Roadmap for Patient Engagement in Imaging CER” has shown that such relevance may not be common.

Many research questions are meaningful to radiologists, but not to patients or their advocates.  Understanding the false-positive rate of a test is important to me.  Patients want to know if a test will tell them if they have cancer, how the test might miss cancer and how many other tests must be performed to rule out cancer.

We need to better understand these outcomes and integrate them to improve our clinical trials.  With support from the Patient-Centered Outcomes Research Institute, that’s what ECOG-ACRIN is doing.  Patient advocates serve on our grant writing committee, workshop planning committee and as workshop team co-leads. This weekend, dozens of patients and patient-advocates will receive CER training at the ACR Learning Center in Reston (follow the related conversation on Twitter with the hashtag, #PCORIimaging).

This training can prepare patients and patient advocates to help with many tasks, such as improving our ability to recruit CER trial subjects and to describe study objectives and results in language that will help patients gain useful answers from what we find.

Our work is not just about reflecting the patient experience. It is changing the culture that determines how scientists approach clinical trials. Valuing the patient experience is helping us develop trials to benefit scientists, patients and patient-advocates alike.

How are you integrating patient input into care at your practice or hospital or into research carried out there?

Please share your thoughts in the comments section below and/or join the discussion on Engage (login required).

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Keeping Up With Explosive IR Growth

Dr. SilvaThis post was contributed by Ezequiel Silva III, FACR, MD, chair of the ACR Commission on Economics and practicing interventional radiologist in San Antonio, TX.

It seems pretty much everywhere you look lately, experts and investors are predicting that interventional radiology (IR) is set for rapid growth. Now we just have to work to ensure that there will be enough clinical interventional radiology practices (and interventional radiologists) to meet the increase demand. The American College of Radiology (ACR) and Society for Interventional Radiology (SIR) are taking steps to help IRs meet that need head-on.

The ACR and SIR created downloadable resources  — including the “IR C-Suite Toolkit” to help IRs educate hospital executives, radiology group officers and other decision makers on the clinical and economic benefits of starting a full-fledged, in-house IR practice.

Available at acr.org/IR, the toolkit helps IRs explain:

  • How IR can help health system executives achieve the health care “triple aim”
  • That IR improves clinical outcomes, recovery times and patient satisfaction — key factors in new delivery and payment models
  • How clinical IR enables health systems to maximize reimbursement in care models that reward facilities for making and keeping patients well instead of payment based on procedural volumes
  • The increasingly valuable role interventional oncology serves in cancer treatment, particularly as the federal government’s Cancer Moonshot effort evolves.

IRs must tell their powerful story of lower costs, less invasive treatment and quicker recovery times. These are primary aims of ongoing health care reform. The audience is there. We just have to take the information to them.

  • Have you had a conversation with your hospital administrators about starting a clinical IR practice?
  • If so what tips might you have for other IRs?
  • Which metrics did you find particularly effective?

Please share your thoughts in the comments section below and/or join the discussion on Engage (login required).

Fighting the Good Fight on LCS

rubingThis post is contributed by Geoffrey D. Rubin, MD, FACR.

Patients and providers were excited when Medicare determined to cover seniors for low-dose CT lung cancer screening (LCS). Why not? Private insurers must cover the exams (with no copay) and LCS can save more lives than any cancer screening test in history. If only it were that simple.

Lung cancer screening is not as widely used as anticipated – in part because Medicare reimbursement is insufficient to support screening programs without cost sharing with non-imaging departments. Journals are publishing papers that selectively ignore National Lung Screening Trial (NLST) data, Lung-RADS® and other current screening protocols resulting in greatly overestimated “harms.” Just as with mammography, many primary care and family doctors may not be giving patients the correct information to make informed decisions.

These are the challenges that ACR members, staff and allied patient groups face in moving lung cancer screening forward. We are working to reduce false positives, educate lawmakers and regulators, and promote use of Lung-RADS® and the Lung Cancer Screening Registry. All of these are necessary to support launch of screening programs nationwide. And the stakes are high.

Lung cancer kills more people each year than breast, prostate and colon cancer combined. Medicine can implement life-saving screening while improving the efficiency of that screening. The ACR and allied organizations will keep working to ensure access to safe, appropriate lung cancer screening and continue to keep you informed of any developments.

In the meantime, please visit the Lung Cancer Screening Resources section on the ACR site for resources to help you inform referring physicians and patients about lung cancer screening and improve the screening you may already be providing.

  • Are you seeing an increase in CT lung cancer screening exams?
  • Do you think that primary care and family physicians have enough information to hold meaningful conversations with patients?
  • What positive steps have you taken to enhance CT lung cancer screening in your institution?
  • What barriers do you face?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).