Table 2.

Barriers and enablers to bladder-sparing strategies for muscle-invasive bladder cancer (MIBC) in Canada

Predominant barriers	Predominant enablers
Belief that radiotherapy has inferior survival compared with cystectomy	‘Champions’ who believe in radiotherapy and advocate for its adoption
Lack of referral from urology to radiation oncology	Belief by urologists that radiation oncologists should present radiotherapy options to all MIBC patients
Belief by urologists that there is a high overall failure rate of first-line radiotherapy	Institutional policy that all MIBC patients should be seen by multiple specialists
Absence of ‘champions’ advocating for the use of radiotherapy in MIBC patients	System-level factors for patient referral (i.e., automatic multidisciplinary referral process; nurse navigator)
Inadequate multidisciplinary collaboration and/or system-level factors conducive to discussing cases (i.e., lack of multidisciplinary clinics)	Patient-driven consultations seeking alternatives to cystectomy