Knowledge of and Compliance With Guidelines in the Management of Non-Muscle-Invasive Bladder Cancer: A Survey of Chinese Urologists

Dan-Qi Wang; Qiao Huang; Xing Huang; Ying-Hui Jin; Yun-Yun Wang; Yue-Xian Shi; Si-Yu Yan; Lu Yang; Bing-Hui Li; Tong-Zu Liu; Xian-Tao Zeng

doi:10.3389/fonc.2021.735704

Knowledge of and Compliance With Guidelines in the Management of Non-Muscle-Invasive Bladder Cancer: A Survey of Chinese Urologists

Front Oncol. 2021 Oct 27:11:735704. doi: 10.3389/fonc.2021.735704. eCollection 2021.

Authors

Dan-Qi Wang^{1

2}, Qiao Huang¹, Xing Huang^{1

2}, Ying-Hui Jin¹, Yun-Yun Wang¹, Yue-Xian Shi³, Si-Yu Yan¹, Lu Yang⁴, Bing-Hui Li^{1

2}, Tong-Zu Liu², Xian-Tao Zeng^{1

2}

Affiliations

¹ Country Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
² Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
³ School of Nursing, Peking University, Beijing, China.
⁴ Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China.

Abstract

Background: Non-muscle-invasive bladder cancer (NMIBC) still poses a heavy load for resulting in many new cases which contribute significantly to medical costs. Although many NMIBC guidelines have been developed, their implementation remains deficient.

Objective: This study was conducted in order to analyze the knowledge of and compliance with the guidelines for NMIBC of Chinese urologists and to identify associated factors.

Methods: We conducted an online survey between August 2019 and January 2021. Respondents who were more than 65 years old or did not give informed consent were excluded. Linear/logistic regressions were performed to identify factors associated with the knowledge of and compliance with the guidelines of urologists, respectively. McNemar's tests were used to explore the divergence between knowledge and compliance.

Results: A total of 814 responses were received, and 98.77% of urologists acknowledged the positive effects of high-quality guidelines. The average knowledge score was 6.10 ± 1.28 (out of a full score of 9), and it was positively associated with educational level and the number of guidelines consulted. Only 1.61% and 39.36% of the respondents realized that the guidelines did not recommend further chemotherapy or BCG infusion for low-risk patients. There were 38.87% and 51.84% respondents "often" or more frequently utilizing BCG therapy for intermediate- and high-risk NMIBC patients, respectively. Divergence between knowledge and compliance in performing a second TURBT after incomplete initial resection reached statistical significance (p < 0.001).

Conclusions: Although the vast majority of urologists acknowledged the positive effects of guidelines, knowledge of and compliance with some recommendations of NMIBC guidelines are still inadequate. Factors associated with guidelines, individual professionals, patients, organizations, and the environment jointly contributed to the non-compliance.

Keywords: guideline; guideline adherence; professional practice; surveys and questionnaires; urinary bladder neoplasms.