Bladder Cancer Coverage from Every Angle

Evaluating Risk-Aligned Bladder Cancer Surveillance Practices

By: Emily Rhode
Posted: Wednesday, December 8, 2021

Research published in JCO Oncology Practice found that many staff members working at Department of Veterans Affairs sites lacked knowledge of how to implement risk-aligned surveillance for patients with bladder cancer effectively. Florian R. Schroeck, MD, MS, of the White River Junction VA Medical Center, Vermont, and colleagues compared practice determinants between sites where risk-aligned surveillance was more or less common.

“Given the differences found between risk-aligned sites and need-improvement sites, implementation strategies will need to address the current lack of routines to incorporate risk-aligned surveillance into clinical workflow,” concluded the authors.

The study included 40 Veterans Affairs staff members: 14 participants at two risk-aligned sites and 26 participants at four need-improvement sites. The researchers used a sequential mixed-methods design to evaluate provider- and facility-level determinants of risk-aligned surveillance. Staff was interviewed using the Tailored Implementation for Chronic Diseases framework (which incorporates 12 prior frameworks based on a systematic literature review). In addition, providers and nurses were asked about their knowledge of the surveillance recommendation for low-, intermediate-, and high-risk non–muscle-invasive bladder cancer.

In addition to a lack of knowledge on guideline recommendations across all sites, researchers found a lack of resources and an absence of routines to incorporate risk-aligned surveillance to be salient determinants at need-improvement sites. Most participants (n = 34) indicated a lack of feedback on whether they were providing risk-aligned surveillance, and almost half (n = 16) thought that more data feedback would be helpful.

Of note, the researchers found that a lack of knowledge does not necessarily mean a lack of risk-aligned surveillance. Several study participants responded that they regularly seek out guideline recommendations.

The researchers recognized several important limitations to their study, including their inability to ask all participants about each of the 57 determinants. They do, however, note that participants were able to answer open-ended questions and that conceptually important determinants were included in their findings.

Disclosure: The study authors’ disclosure information can be found at

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