Improvement Stories:
Focusing on What’s Best in Care, Not Just What’s Routine: New Guidelines for Using Technology Wisely
The development of a new guideline for the care of patients with Hodgkin’s lymphoma began with a group of clinical oncologists, radiologists, and radiation oncologists from BWH, MGH and Dana-Farber Cancer Institute. The group studied how a certain kind of technology for taking pictures inside the body – called Positron Emission Tomography, or PET scans – was used for patients with Hodgkin’s lymphoma who had successfully finished their treatment. The group’s goal was to determine the best way to ensure that their lymphoma did not reoccur, but without overusing a costly technology. The doctors began by reviewing existing national guidelines as well as current practices within our hospitals and around the world. Most importantly, they looked at the charts of our own patients to find out what has worked best.
The most telling finding from this study was the number of times that follow-up PET incorrectly showed a return of the lymphoma. In addition to causing the patient unnecessary concern, these “false positives” could result in follow-up procedures that may be uncomfortable and unnecessary for patients.
The group concluded that routine follow-up PET scanning on patients whose scans showed nothing at the end of their treatment did little good, and the number of false positives generated by follow-up PET scanning had a negative impact on patients. Armed with this knowledge, the group created a Partners-wide guideline to make sure PET scanning is used only when it has the most benefit.