Barriers to Change: Adopting New Therapies

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Barriers to change are real or perceived issues that may prevent physicians from applying best practices. Knowledge of the nature and magnitude of these barriers helps educational designers address these barriers within the scope of the interventions, thereby allowing for changes in physician performance as compared to changes in knowledge. In order to assess the impact of barriers to best practices in treating geriatric patients with cancer, respondents were asked to rate the extent to which they saw each item as a barrier to best practices, from 1 (low) to 5 (high) (Figure A13). These barriers were derived from the interviews, expert opinions, and the literature on physician change. Average responses are depicted below.

Figure A13.  Barriers to care.

All of the barriers except “Lack of insurance coverage” are above the midpoint of 3, suggesting that these particular issues present barriers to best care of geriatric patients with cancer. The highest-rated items were “Lack of data specifically for geriatric patients” and “Unknown effects of comorbidities,” confirming that a lack of quality clinical trial data focused on geriatric patients has left clinicians in the dark when trying to make the best treatment decisions for their patients. The barrier “High cost to patients” also scored well over the midpoint, highlighting that most geriatric patients are on fixed incomes and lack other necessary supports (ie, relying on a relative for transportation; directives to eat a specific, unaffordable diet). The busy schedules of medical oncologists are revealed by the barrier ranked next, which indicates that time is of the essence, and often clinicians feel they do not have enough time to achieve the level of study they would prefer. The “Lack of insurance coverage” barrier is ranked less than 3.0, which is indicative of physicians feeling neutral about or disagreeing that this is a barrier.

These data were further evaluated to identify the percentage of physicians who rated each barrier as “High” (4 or 5). As expected, the percentage of physicians who rated the barriers very high aligned with the overall highly rated barriers (Table A1).

Table A1. Highest-rated barriers to care.