Table 4.
System-level enablers to the referral/use of chemotherapy among patients with muscle-invasive bladder cancer
| Survey questions related to the TDF Domain | Urologists No. (%)* | Medical Oncologists No. (%)* | Radiation Oncologists No. (%)* |
| Environmental context and resources | |||
| Multidisciplinary case conferences | (N = 81) | (N = 43) | (N = 39) |
| Our GU multidisciplinary case conferences are helpful to discuss treatment options for patients with MIBC | |||
| Strongly Agree/Agree | 79% | 86% | 85% |
| Our GU multidisciplinary case conferences are well attended by urology | |||
| Strongly Agree/Agree | 77% | 74% | 77% |
| Our GU multidisciplinary case conferences are well attended by medical oncology | |||
| Strongly Agree/Agree | 93% | 100% | 95% |
| Our GU multidisciplinary case conferences are well attended by radiation oncology | |||
| Strongly Agree/Agree | 90% | 95% | 90% |
| Our GU multidisciplinary case conferences result in a larger proportion of MIBC patients receiving NACT/ACT. | |||
| Strongly Agree/Agree | 67% | N/A∧ | 51% |
| Multidisciplinary bladder clinics | N = 23 | N = 11 | N = 8 |
| Our multidisciplinary clinic for bladder cancer has resulted in more patients being treated with NACT/ACT | |||
| Strongly Agree/Agree | 78% | 82% | 88% |
| Nurse Navigator | N = 61 | N = 32 | N = 28 |
| Our institution has a nurse navigator that helps with the patient referral system | |||
| Yes | 49% | 50% | 39% |
| Institutional Policy to ensure MIBC patients are seen by medical oncology, urology and radiation oncology | N = 6 | N = 8 | N = 11 |
| More patients with MIBC are receiving NACT/ACT at our center since we instituted a policy that patients are to be referred to medical oncology | |||
| Strongly Agree/Agree | 67% | 6(75%) | 9(82%) |
| Medical Oncologists with GU expertise | N = 66 | N = 42 | N = 39 |
| The percentage of MIBC patients at our center who get NACT/ACT increased after we obtained GU MO expertise | |||
| Strongly Agree/Agree | 56% | 52% | 59% |
*Only participants with access to these system-level factors/resources were able to answer. For this reason the “N” for each set of questions is different. ∧This question was not included in the medical oncology survey. Abbreviations: TDF, Theoretical Domains Framework; GU, genitourinary; NACT, neoadjuvant chemotherapy; ACT, adjuvant chemotherapy; MIBC, muscle-invasive bladder cancer; MO, medical oncology.