Collaboration on recommendations for ovarian, adnexal cysts improves adherence

Radiologists may be more likely to adhere to collaborative follow-up recommendations developed at the institutional level than pre-existing recommendations from a larger organization, according to a recent study published by the Journal of the American College of Radiology.

Researchers at NYU Langone Medical Center in New York City observed that radiologist adherence to recommendations developed in 2010 by the Society of Radiologists in Ultrasound (SRU) for the management of asymptomatic ovarian and adnexal cysts was just 59 percent. The team, fearing such a statistic could potentially lead to increased overutilization, was inspired to plan an intervention by collaborating with colleagues from the institution’s division of gynecologic oncology on a new set of recommendations for the management of asymptomatic ovarian and adnexal cysts.

“Referring clinicians might be more confident and reassured in adhering to radiologist recommendations knowing that the recommendations were supported by both gynecologic oncology and radiology,” lead author Danny C. Kim, MD, department of radiology at NYU Langone Medical Center, and colleagues wrote. “Patients may be confused when they receive conflicting management recommendations from radiologists and gynecologists within the same medical center. Development of these recommendations at an institutional level would likely enhance patient confidence in health care providers. By improving the level of collaboration between specialties, not only is patient care improved, but the patient experience is enhanced.”

Several meetings later, the new recommendations were born, taking the SRU’s standards and then modifying them based on the collaborators’ personal experiences.

The authors noted two specific changes with the new collaborative recommendations: 1.) In postmenopausal women, the threshold for simple cysts that do not need follow-up was changed from  ≤1 cm to  ≤2 cm, and 2.) In premenopausal women, a 6-month follow-up was added for simple cysts >3 and ≤5 cm.

The team then compared the adherence to these new recommendations from February 2014 to November 2014 to the adherence of appropriate recommendations from January 2012 to January 2014.

Overall, Kim et al. found that radiologists followed the later collaborative recommendations 80 percent of the time, and overmanagement was pegged at 10 percent. In contrast, from January 2012 to January 2014 the study found an adherence rate of 50 percent and overmanagement rate of 34 percent.

“This collaboration emphasized the importance of the appropriate management of common and incidental findings on imaging examinations,” the authors wrote. “Our results show that the intervention resulted in improved radiologist adherence to management algorithms and reduced overmanagement, potentially reducing overutilization.”

In addition, with the collaborative recommendations, clinical adherence to radiologist follow-up recommendations increased from 49 percent to 57 percent.

“A possible explanation for why the clinician adherence rate did not substantially improve is that although regular updates at radiology section meetings encouraged participation and adherence, such updates and communication were not shared with referring clinicians,” the authors wrote. “Furthermore, multiple patient factors may contribute to a referring clinician’s choice of follow-up, which may appropriately vary from the radiologist recommendation.”

The authors noted that their study did have some limitations. For example, old radiology reports were studied retrospectively by searching for specific words, so it is possible some applicable reports were missed entirely. Also, patient outcomes were not assessed, which could have provided the research with another layer of potentially insightful information.