title: Making decisions about cancer screening when the guidelines are unclear or conflicting.
abstract: OBJECTIVE
  Our purpose was to determine the factors involved in the cancer screening decisions of family physicians in situations where the clinical practice guidelines are unclear or conflicting as opposed to when they are clear and uncontroversial.
  
  
  METHODS
  We analyzed discussions with focus groups using a constant comparative approach.
  
  
  METHODS
  A total of 73 family physicians in active practice participated in 10 focus groups (1 urban group and 1 rural group in each of 5 Canadian provinces).
  
  
  METHODS
  Our main outcome measures were participants' perceptions regarding cancer screening when the guidelines were unclear or conflicting.
  
  
  RESULTS
  We propose a model of the determinants of cancer screening decision making with regard to unclear and conflicting guidelines. This model is rooted in the physician-patient relationship, and is an interactive process influenced by patient factors (anxiety, expectations, and family history) and physician factors (perception of guidelines, clinical practice experience, influence of colleagues, distinction between the screening styles of specialists and family physicians, and the amount of time and financial costs involved in performing the maneuver).
  
  
  CONCLUSIONS
  Our model is unique, because it is embedded in the physician-patient relationship. Ultimately, a modified model could be used to design interventions to assist with the implementation of preventive services guidelines.
authors.affiliation: State University of New York Upstate Medical University, Suite 200, 475 Irving Ave, Syracuse, NY 13210, USA. tudiverf@upstate.edu.
authors.forename: F
authors.initials: F
authors.lastname: Tudiver
authors.forename: J B
authors.initials: JB
authors.lastname: Brown
authors.forename: W
authors.initials: W
authors.lastname: Medved
authors.forename: C
authors.initials: C
authors.lastname: Herbert
authors.forename: P
authors.initials: P
authors.lastname: Ritvo
authors.forename: R
authors.initials: R
authors.lastname: Guibert
authors.forename: J
authors.initials: J
authors.lastname: Haggerty
authors.forename: V
authors.initials: V
authors.lastname: Goel
authors.forename: P
authors.initials: P
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: O'Beirne
authors.forename: A
authors.initials: A
authors.lastname: Katz
authors.forename: P
authors.initials: P
authors.lastname: Moliner
authors.forename: A
authors.initials: A
authors.lastname: Ciampi
authors.forename: J I
authors.initials: JI
authors.lastname: Williams
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005194:Family Practice / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D008960:Models, Psychological; D009369:Neoplasms / Q000175:diagnosis*; D018579:Patient Selection; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000706:statistics & numerical data