Cary, ClintMilitello, LauraDeChant, PaigeFrankel, RichardKoch, Michael O.Weiner, Michael2020-10-022020-10-022020Cary, C., Militello, L., DeChant, P., Frankel, R., Koch, M. O., & Weiner, M. (2020). Barriers to Single-Dose Intravesical Chemotherapy in Non-muscle Invasive Bladder Cancer: What's the Problem?. Urology Practice, 10-1097. https://doi.org/10.1097/UPJ.0000000000000174https://hdl.handle.net/1805/23980Introduction: The intravesical instillation of mitomycin C immediately following surgery for non-muscle invasive bladder cancer has been shown to be efficacious in reducing cancer recurrence. As a result, the American Urological Association adopted guidelines for non-muscle invasive bladder cancer care to support its use in low to intermediate risk patients. Despite this, urologists' use of this drug following transurethral resection of a bladder tumor (TURBT) has been reported as low as 5% or less. Our study objective was to better understand the barriers urologists experience in using mitomycin C. Methods: Semi-structured interviews were conducted with 13 practicing urologists at 4 geographically distinct practice locations throughout Indiana between 2017 and 2018. Cognitive task analysis was used to explore factors that influenced their clinician decision-making about Mitomycin C use following TURBT in specific patient cases. Interview transcripts were coded and analyzed using immersion/crystallization to identify emergent themes. Results: The median age of the urologists interviewed was 44 (IQR 40-48). Eighty-five percent were male. Approximately 30% had completed urologic fellowship training; 62% were in private practice. Three major themes related to the use of mitomycin C emerged: cumbersome workflow processes, urologists' fears of side effects, and issues of identifying patients most likely to benefit. Conclusion: Workflow, fear, and value are key factors and also represent complexities of translating efficacy into effectiveness for a drug with known benefits to patients. Areas of potential intervention development to improve the use of mitomycin C to reduce recurrence of bladder cancer are suggested. Alternatives such as gemcitabine may also help overcome these barriers.enPublisher Policynon-muscle invasive bladder cancermitomycin Ccancer recurrenceArticle