In September, I was fortunate enough to attend the 4th international conference on Preventing Overdiagnosis in Barcelona, Spain. This was my first time attending the Preventing Overdiagnosis Conference (POD), which has been held at Dartmouth (2013), University of Oxford (2014), and NIH (2015) in the past. This year, the conference was hosted by the Agency for Health Quality and Assessment (AQuAS) of the Ministry of Health of the government of Catalonia as well as many associate partners.
Briefly, the conference is focused on bringing together researchers, practitioners, policymakers, patients, consumer/citizen advocates, journalists, and other important stakeholder groups to share ideas, report on research findings, discuss ways to advance the field, and debate ways to advance the field and prevent overdiagnosis. It many ways, the overall theme and climate of the conference reminded me of the annual D&I Conference in Health; it was really nice to see a diverse group of stakeholder representatives and important themes that cut across health topics, delivery settings, and content areas. The conference also had a nice mix of presentation formats, including 90-minute workshops (e.g., 2-3 presentations followed by discussion with panelists and attendees) and 3-minute elevator pitches as well as the more traditional formats of panel presentations, plenaries, and posters.
In collaboration with colleagues, I organized a 90-minute workshop during the conference as well as a 3-hour interactive session during Research Day, held immediately following the conference. Both sessions were focused on advancing the science of de-implementation of ineffective, harmful, inappropriate, and/or unproven health practices, programs, interventions, guidelines, and treatments. The sessions focused mostly on ways to advance the science around reducing or stopping the use of such programs although ways to prevent their introduction and adoption in systems and care settings were also discussed (e.g., replication and reproducibility studies, higher threshold for warranting introduction of practices, etc.).
The conference workshop included three brief presentations followed by a 45-minute open discussion with attendees. Dr. Russ Harris (UNC) led the session discussing potential patient- and provider-level strategies for de-implementation, followed by Dr. Barry Kramer (NCI) on policy-level strategies for de-implementation, and concluded with an overview presentation on de-implementation by myself. Attendees provided great comments, suggestions, examples, and questions about our specific presentations as well as the overall topic of de-implementation. We discussed the importance of studying de-implementation as an important next step in preventing and curbing overscreening, overdiagnosis, and overtreatment and some of the barriers to actual de-implementation.
In collaboration with Drs. Barry Kramer (NCI) and Karsten Juhl Jorgensen (Nordic Cochrane Center), the Research Day session included two presentations, two breakout working groups, summaries, and identification of next steps. Dr. Jorgensen discussed the process for developing 10 criteria for de-implementation and I presented challenges associated with advancing the science of de-implementation (e.g., study designs, measures, outcomes). Attendees split into two groups to further discuss each topic area, both of which were stimulating, informative, and constructive. Each group identified next steps for advancing each separate but related topic and established ways to continue ongoing conversations and discussions within and between the groups.
Overall, it was a wonderful experience and I really appreciate my colleagues’ collaboration on the presentations (thank you Barry, Russ and Karsten!) as well as the incredible feedback from attendees. I look forward to continuing to discuss this topic and work with everyone to try to move the needle forward in terms of advancing research in this area.
Note that the next POD conference will be held in Quebec (August 2017)—details available here.
Congratulations to my NCI colleagues who also presented at the POD conference, including (but not limited) to those particularly relevant to de-implementation and implementation science (i.e., workshops, posters, panel presentations):
· De-implementation: Individualized cancer screening decisions as a way to achieve optimal care for older adults (Dr. Erica Breslau);
· The US PROSPR Research Network: A platform for studying overdiagnosis in the community setting (Dr. Paul Doria-Rose);
· Cancer overdiagnosis: Discussing our disagreements (Dr. Pamela Marcus).