What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting?
OBJECTIVE
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.


METHODS
National Canadian mail survey of randomly selected family physicians.


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


METHODS
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.
D000328:Adult; D001943:Breast Neoplasms / Q000517:prevention & control*; D002170:Canada; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000517:prevention & control*
D017430:Prostate-Specific Antigen