title: Multiple clinical practice guidelines for breast and cervical cancer screening: perceptions of US primary care physicians.
abstract: BACKGROUND
  Multiple clinical practice guidelines exist for breast and cervical cancer screening, and differ in aggressiveness with respect to the recommended frequency and target populations for screening.
  
  
  OBJECTIVE
  To determine (1) US primary care physicians' (PCPs) perceptions of the influence of different clinical practice guidelines; (2) the relationship between the number, aggressiveness, and agreement of influential guidelines and the aggressiveness of physicians' screening recommendations; and (3) factors associated with guideline perceptions.
  
  
  METHODS
  A nationally representative sample of 1212 PCPs was surveyed in 2006-2007. Cross-sectional analyses examined physicians' perceptions of the influence of different breast and cervical cancer screening guidelines, the relationship of guideline perceptions to screening recommendations in response to hypothetical vignettes, and the predictors of guideline perceptions.
  
  
  RESULTS
  American Cancer Society and American College of Obstetricians and Gynecologists guidelines were perceived as more influential than other guidelines. Most physicians (62%) valued multiple guidelines, and conflicting and aggressive rather than conservative guideline combinations. The number, aggressiveness, and agreement of influential guidelines were associated with the aggressiveness of screening recommendations (P < 0.01)-which was highest for physicians valuing multiple-aggressive, lowest for physicians valuing multiple-conservative, and intermediate for physicians valuing multiple-conflicting, single, and no guidelines. Obstetrician/gynecologists specialty predicted valuation of aggressive guidelines (P < 0.001).
  
  
  CONCLUSIONS
  PCPs' perceptions of cancer screening guidelines vary, relate to screening recommendations in logically-consistent ways, and are predicted by specialty and other factors. The number, aggressiveness, and agreement of valued guidelines are associated with screening recommendations, suggesting that guideline multiplicity is an important problem in clinical decision-making.
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME 04101, USA. hanp@mmc.org
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.forename: Gigi
authors.initials: G
authors.lastname: Yuan
authors.forename: Alyssa
authors.initials: A
authors.lastname: Grauman
authors.forename: William W
authors.initials: WW
authors.lastname: Davis
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D018579:Patient Selection; D058007:Physicians, Primary Care / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*