title: Clinicians' knowledge and attitudes about breast symptom management: is there a use for clinical guidelines?
abstract: OBJECTIVE
  Failure to appropriately manage women with breast symptoms has resulted in delays in breast cancer diagnoses. We examined clinicians' knowledge and attitudes about breast symptoms and pilot tested an intervention aimed at improving these outcomes.
  
  
  METHODS
  We conducted a controlled trial within an office-based primary care setting. Clinicians in the study and control groups completed a baseline survey. The study group received breast symptoms-related guidelines at the point of care; the control group received no intervention. Both groups completed follow-up surveys. Paired t tests were used to compare differences in presurvey and postsurvey responses among clinicians in the two groups.
  
  
  RESULTS
  One hundred one clinicians participated in the baseline survey (response rate 83%), 55 in the study group and 46 in the control group. About 18% and 11% of clinicians in the study and control groups, respectively, reported the use of the breast-related clinical guidelines (p = 0.32). At baseline, clinicians in both groups had variable knowledge of breast symptom management (correct responses per item ranged from 50% to 97%). Although their attitudes were positive, 21% were uncomfortable with their knowledge of breast cancer risk factors, and 27% were uncomfortable with their skills in identifying and 11% in managing a palpable mass. Following the intervention, the use of either guideline was significantly higher in the study group than in the control group (38% vs. 17%, p = 0.032), but there were no statistically significant differences in the clinicians' knowledge or attitudes.
  
  
  CONCLUSIONS
  Clinicians' knowledge of breast symptoms management varied, and some reported discomfort in their level of knowledge and skills. Although our pilot intervention improved the use of clinical guidelines, it had no statistically significant impact on clinicians' knowledge or attitudes.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts 02215, USA. Larissa-Nekhlyudov@vmed.org
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Mayra
authors.initials: M
authors.lastname: Nicola
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Buechler
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D002983:Clinical Competence; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires