TY - JOUR
T1 - New technologies meeting old professional boundaries
T2 - The emergence of carotid artery stenting
AU - Lang, Patrick O.
AU - Schwarze, Margaret L.
AU - Alexander, G. Caleb
N1 - Funding Information:
This research was supported by the MacLean Center for Clinical Medical Ethics and the Pritzker School of Medicine. The funding sources had no role in the collection of data, analysis, interpretation, or reporting of data, or in the decision to submit the article for publication.
PY - 2005/6
Y1 - 2005/6
N2 - BACKGROUND: Carotid artery stenosis is common and costly. Opinions differ in regard to the impact that carotid angioplasty and stenting (CAS) will have. Vascular surgeons, cardiologists, interventional radiologists, and neurologists all have a stake in the uptake of CAS. We sought to explore physicians' views about the safety and efficacy of CAS and the negotiation of professional boundaries in the treatment of carotid stenosis. STUDY DESIGN: We performed a qualitative analysis of key informant interviews with 15 physicians, including four internationally renowned key opinion leaders, representing five medical centers with differing experience adopting CAS. RESULTS: Variation in beliefs about the safety and efficacy of CAS within specialties was overshadowed by variation across the specialties examined. Most informants emphasized the strengths of their specialty in adopting CAS, including frequent patient care (vascular surgery, cardiology, and neurology), extensive catheter experience (cardiology, interventional radiology), and intimate knowledge of the anatomy of vascular and neurovascular disease (vascular surgery, neurology). Several themes were mentioned in regard to the diffusion of CAS, including risks of premature diffusion into low risk populations and the role of patient preferences in CAS uptake. The most common theme in regard to local management of CAS was the strength of interdisciplinary collaboration in the management of patients with carotid artery stenosis. CONCLUSIONS: CAS challenges physicians from several specialties to safely and effectively manage the uptake of an emerging technology crossing traditional specialty lines. Local collaboration of individual physicians and the departments and professional organizations they comprise, will have an important impact on how this technology is adopted.
AB - BACKGROUND: Carotid artery stenosis is common and costly. Opinions differ in regard to the impact that carotid angioplasty and stenting (CAS) will have. Vascular surgeons, cardiologists, interventional radiologists, and neurologists all have a stake in the uptake of CAS. We sought to explore physicians' views about the safety and efficacy of CAS and the negotiation of professional boundaries in the treatment of carotid stenosis. STUDY DESIGN: We performed a qualitative analysis of key informant interviews with 15 physicians, including four internationally renowned key opinion leaders, representing five medical centers with differing experience adopting CAS. RESULTS: Variation in beliefs about the safety and efficacy of CAS within specialties was overshadowed by variation across the specialties examined. Most informants emphasized the strengths of their specialty in adopting CAS, including frequent patient care (vascular surgery, cardiology, and neurology), extensive catheter experience (cardiology, interventional radiology), and intimate knowledge of the anatomy of vascular and neurovascular disease (vascular surgery, neurology). Several themes were mentioned in regard to the diffusion of CAS, including risks of premature diffusion into low risk populations and the role of patient preferences in CAS uptake. The most common theme in regard to local management of CAS was the strength of interdisciplinary collaboration in the management of patients with carotid artery stenosis. CONCLUSIONS: CAS challenges physicians from several specialties to safely and effectively manage the uptake of an emerging technology crossing traditional specialty lines. Local collaboration of individual physicians and the departments and professional organizations they comprise, will have an important impact on how this technology is adopted.
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U2 - 10.1016/j.jamcollsurg.2004.12.022
DO - 10.1016/j.jamcollsurg.2004.12.022
M3 - Article
C2 - 15922195
AN - SCOPUS:19744376086
SN - 1072-7515
VL - 200
SP - 854
EP - 860
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -