Adoption, consistency, and usability of NICE vs EAU guidelines in low- and intermediate-risk NMIBC: a cross-sectional survey of UK urologists.

Abstract

To evaluate current adoption of guidelines for low- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC) in the UK and to assess clinicians' ability to apply their chosen guideline consistently to real-world clinical scenarios. This study is a cross-sectional survey distributed to clinicians involved in the management of NMIBC in the UK. Respondents reported their unit-level and personal guideline adoption (National Institute for Health and Care Excellence [NICE] vs European Association of Urology [EAU]) and completed three case-based real-life scenarios derived from NMIBC cases with discordant risk stratification between NICE and EAU guidelines. Cases were randomly selected from a local database using a computer-generated random number function in Microsoft Excel. Concordance between respondents' decisions and their stated guideline was assessed for risk stratification and surveillance duration. A total of 174 eligible responses were analysed. Most units (38%) followed NICE guidelines, but individual clinicians most frequently reported that they were following EAU guidelines (39%). Those who followed NICE guidelines demonstrated significantly higher compliance with the duration of follow-up as recommended in the guidelines than did those who followed EAU guidelines (78.9% vs 49.2%, P < 0.001). Deviations from the guidelines for those who followed NICE were predominantly in duration of surveillance, which was longer than recommended. Conversely, those following EAU guidelines frequently opted for shorter-than-recommended follow-up (P < 0.001). Consistent guideline-based risk stratification was achieved in 77.1% of those following NICE guidelines and 34.1% of those following EAU guidelines (P < 0.001). Acceptable recurrence risk at discharge did not differ between guideline groups (P = 0.278). Substantial variation exists in NMIBC guideline adherence and real-world application in the UK. NICE guidance was associated with greater consistency and utility compared with EAU guidance for low- and intermediate-risk disease. These findings highlight the need for clearer, unified recommendations to promote equitable care and rational use of surveillance resources.