Using decision tree models to depict primary care physicians CRC screening decision heuristics.
OBJECTIVE
The purpose of this study was to identify decision heuristics utilized by primary care physicians in formulating colorectal cancer screening recommendations.


METHODS
Qualitative research using in-depth semi-structured interviews.


METHODS
We interviewed 66 primary care internists and family physicians evenly drawn from academic and community practices. A majority of physicians were male, and almost all were white, non-Hispanic.


METHODS
Three researchers independently reviewed each transcript to determine the physician's decision criteria and developed decision trees. Final trees were developed by consensus. The constant comparative methodology was used to define the categories.


RESULTS
Physicians were found to use 1 of 4 heuristics ("age 50," "age 50, if family history, then earlier," "age 50, if family history, then screen at age 40," or "age 50, if family history, then adjust relative to reference case") for the timing recommendation and 5 heuristics ["fecal occult blood test" (FOBT), "colonoscopy," "if not colonoscopy, then...," "FOBT and another test," and "a choice between options"] for the type decision. No connection was found between timing and screening type heuristics.


CONCLUSIONS
We found evidence of heuristic use. Further research is needed to determine the potential impact on quality of care.
Wackerbarth
Sarah B
SB
Martin School of Public Policy and Administration, University of Kentucky, 435 Patterson Office Tower, Lexington, KY, USA. sbwack0@uky.edu
Tarasenko
Yelena N
YN
Curtis
Laurel A
LA
Joyce
Jennifer M
JM
Haist
Steven A
SA
D000328:Adult; D001294:Attitude to Health; D002983:Clinical Competence; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003657:Decision Making; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
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