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What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting?
J Fam Pract. 2002 Sep; 51(9):760.JF

Abstract

OBJECTIVES

To determine (a) the respondents' perceptions of 4 unclear or conflicting cancer screening guidelines: prostate-specific antigen (PSA) for men over 50, mammography for women 40-49, colorectal screening by fecal occult blood testing (FOBT), and colonoscopy for patients over 40; and (b) the influence of various factors on the decision to order these tests.

STUDY DESIGN

National Canadian mail survey of randomly selected family physicians.

POPULATION

Family physicians in active practice (n=565) selected from rural and urban family medicine sites in 5 provinces representing the main regions in Canada.

OUTCOME MEASURED

Agreement with guideline statements, and decision to order screening test in 6 clinical vignettes.

RESULTS

Of 565 surveys mailed, 351 (62.1%) were returned. Most respondents agreed with the Canadian Task Force recommendations, and most believed that various guidelines for 3 of the 4 screens were conflicting (PSA 86.6%; mammography 67.5%; FOBT 62.4%). Patient anxiety about cancer, patient expectations of being tested, and a positive family history of cancer increased the odds that the 4 tests would be ordered. A good quality patient-MD relationship decreased the odds of ordering a mammogram. Screening decisions were also significantly influenced by the respondents' beliefs about whether screening was recommended and whether screening could cause more harm than good. A physician's sensitivity to his or her colleagues' practice influenced screening decisions regarding PSA and mammography.

CONCLUSIONS

These results suggest a conceptual framework for understanding the determinants of screening behavior when guidelines are unclear or conflicting.

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Authors+Show Affiliations

Tudiver F
Department of Family Medicine, East Tennessee State University, Box 70621, Johnson City, TN 37614, USA. tudiverf@etsu.edu
Guibert R
No affiliation info available
Haggerty J
No affiliation info available
Ciampi A
No affiliation info available
Medved W
No affiliation info available
Brown JB
No affiliation info available
Herbert C
No affiliation info available
Katz A
No affiliation info available
Ritvo P
No affiliation info available
Grant B
No affiliation info available
Goel V
No affiliation info available
Smith P
No affiliation info available
O'Beirne M
No affiliation info available
Williams JI
No affiliation info available
Moliner P
No affiliation info available

MeSH

AdultBreast NeoplasmsCanadaColonoscopyColorectal NeoplasmsFamily PracticeFemaleHumansLogistic ModelsMaleMammographyMass ScreeningMiddle AgedOccult BloodPhysician-Patient RelationsPractice Guidelines as TopicPractice Patterns, Physicians'Prostate-Specific AntigenProstatic Neoplasms

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12366894

Citation

Tudiver, Fred, et al. "What Influences Family Physicians' Cancer Screening Decisions when Practice Guidelines Are Unclear or Conflicting?" The Journal of Family Practice, vol. 51, no. 9, 2002, p. 760.
Tudiver F, Guibert R, Haggerty J, et al. What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting? J Fam Pract. 2002;51(9):760.
Tudiver, F., Guibert, R., Haggerty, J., Ciampi, A., Medved, W., Brown, J. B., Herbert, C., Katz, A., Ritvo, P., Grant, B., Goel, V., Smith, P., O'Beirne, M., Williams, J. I., & Moliner, P. (2002). What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting? The Journal of Family Practice, 51(9), 760.
Tudiver F, et al. What Influences Family Physicians' Cancer Screening Decisions when Practice Guidelines Are Unclear or Conflicting. J Fam Pract. 2002;51(9):760. PubMed PMID: 12366894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting? AU - Tudiver,Fred, AU - Guibert,Remi, AU - Haggerty,Jeannie, AU - Ciampi,Antonio, AU - Medved,Wendy, AU - Brown,Judith Belle, AU - Herbert,Carol, AU - Katz,Alan, AU - Ritvo,Paul, AU - Grant,Bill, AU - Goel,Vivek, AU - Smith,Philip, AU - O'Beirne,Maeve, AU - Williams,J Ivan, AU - Moliner,Peter, PY - 2002/10/9/pubmed PY - 2002/10/31/medline PY - 2002/10/9/entrez SP - 760 EP - 760 JF - The Journal of family practice JO - J Fam Pract VL - 51 IS - 9 N2 - OBJECTIVES: To determine (a) the respondents' perceptions of 4 unclear or conflicting cancer screening guidelines: prostate-specific antigen (PSA) for men over 50, mammography for women 40-49, colorectal screening by fecal occult blood testing (FOBT), and colonoscopy for patients over 40; and (b) the influence of various factors on the decision to order these tests. STUDY DESIGN: National Canadian mail survey of randomly selected family physicians. POPULATION: Family physicians in active practice (n=565) selected from rural and urban family medicine sites in 5 provinces representing the main regions in Canada. OUTCOME MEASURED: Agreement with guideline statements, and decision to order screening test in 6 clinical vignettes. RESULTS: Of 565 surveys mailed, 351 (62.1%) were returned. Most respondents agreed with the Canadian Task Force recommendations, and most believed that various guidelines for 3 of the 4 screens were conflicting (PSA 86.6%; mammography 67.5%; FOBT 62.4%). Patient anxiety about cancer, patient expectations of being tested, and a positive family history of cancer increased the odds that the 4 tests would be ordered. A good quality patient-MD relationship decreased the odds of ordering a mammogram. Screening decisions were also significantly influenced by the respondents' beliefs about whether screening was recommended and whether screening could cause more harm than good. A physician's sensitivity to his or her colleagues' practice influenced screening decisions regarding PSA and mammography. CONCLUSIONS: These results suggest a conceptual framework for understanding the determinants of screening behavior when guidelines are unclear or conflicting. SN - 0094-3509 UR - https://www.unboundmedicine.com/medline/citation/12366894/What_influences_family_physicians'_cancer_screening_decisions_when_practice_guidelines_are_unclear_or_conflicting L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=12366894.ui DB - PRIME DP - Unbound Medicine ER -