Lung Cancer Patient Follow-Up* Motivation of Thoracic Surgeons Katherine S. Virgo, PhD; Keith S. Naunheim, MD, FCCP; Margaret A. Coplin, MS; and Frank E. johnson, MD Study objectives: To analyze variation in beliefs that potentially motivate thoracic surgeons in the design of posttreatment surveillance strategies for lung cancer patients and to examine the relationship between motivation and follow-up intensity. Design: International survey. Setting: Ambulatory care. Participants: All 3,700 members of the Society of Thoracic Surgeons were surveyed to measure their follow-up practices during the 5-year period after treatment, physician beliefs, and variation in these beliefs. The relationship between beliefs, as potentially motivating factors, and follow-up intensity was also analyzed. Measurements and results: Age, General Thoracic Surgery Club membership, percentage of practice that was noncardiac, South Central United States practice location, and overseas practice location were most frequently related to beliefs that potentially motivate physicians in the design of surveillance strategies. When viewed independently of follow-up practice patterns, thoracic surgeons appear to be motivated by the desire to please patients, avoid malpractice suits, and improve patient quality of life. When viewed in relation to self-reported follow-up, none of these motivating factors were consistently associated with follow-up intensity. Belief in curative treatment of recurrence and enhanced likelihood of immediate palliative treatment leading to improved survival were the factors most frequently associated with variation in follow-up. Although the ability of the logistic and stepwise regression models to predict test use and follow-up intensity was less than optimal for TNM stage I patients, predictive ability was substantially improved for TNM stage II and III patients by including earlier-stage practice patterns as an independent variable. Conclusions: Physician characteristics and beliefs predicted a less than expected amount of the variation in self-reported follow-up intensity by TNM stage when modelled without knowledge of follow-up practice for any other TNM stage. Discrepancies between self-reported and actual follow-up may be partially responsible, although lack of surveillance guidelines is more likely. The inclusion of barriers to follow-up may improve future mode1s. (CHEST 1998; 114:1519-1534) Key words: follow-up; lung cance r; physician beliefs; physician motivation; practice patterns; self-report; surveillance; thoracic surgeons Abbreviations: AATS =American Association for Thoracic Surgety; CI =confidence interval ; CXR =chest GTSC = General Thoracic Surgery Club; HBM = Health Belief Model; LIT = liver function test; QOL = quality of life; RCST = routine clinical surveillan ce testing; SSO = Society for Surgical Oncology; STS = Society of Thoracic Surgeons J t is estimated that 177,000 new cases of primary lung cancer will be diagnosed in th e United States this year. 1 Of the 35,000 patients undergoing resec- *From the Department of Surgery (Drs. Virgo, aunheim, and Johnson ), St. Louis University Health Sciences Center, and the Surgical Service (Drs. Virgo, Naunheim, and Johnson, and Ms. Cop1in ), Department of Veterans Affairs Medical Center, St. Louis , MO. Manuscript received October 8, 1997; revision accepted April20, 1998. The vi ews expressed in this paper are those of the au thors and should not be construed as reflecting the official position of St. Louis University or the Department of Veterans Affairs. Correspondence to: Katherine S. Virgo, PhD, Health Seruices Research, Department of Surgery, St. Louis Unit:ersity Health Scie nces Center, 3635 Vi sta At:e, PO Box 15250, St. Loui s, MO 63110-0250; e-mail: virgoks@slu.edu tion and en t ering follow-up, few of those who de- velop recurrences can be curatively tr eated. 2 Th e outlook is more positive for the approximately 2 to 3% who will develop second primary cance rs each year, 40 to 70% of whom can be curatively treat ed . 3 - 7 No widely accepted practice guidelines exist for posttreatment follow-up of lung cancer patients, although various recommendations have been pub- lished.3-4·8-21 Recommended follow-up strategies vary widely, resulting in a similarly wide range of cos ts. Medicare-allowed charges for 5 years of post- treatment follow-up can range from a low of $946 to a high of $5,645 . Charges for non-Medicare patients can range from $1,533 to $9,145. 8 CHEST/114/6/DECEMBER, 1998 1519