title: Discontent and Confusion: Primary Care Providers' Opinions and Understanding of Current Cervical Cancer Screening Recommendations.
abstract: BACKGROUND
  In 2012, new cervical cancer screening guidelines were published by three widely recognized entities which advocate delayed onset of testing, fewer screenings, selective use of human papilloma virus co-testing, and no further screening in women over age 65 years. Early observations report that these recommendations are not being followed and overscreening is common. This study seeks to understand why primary care providers might not adhere to these new 'best practice' health policy protocols.
  
  
  METHODS
  A total of 4,909 randomly selected primary care providers (physicians, nurse practitioners, and physician assistants) practicing in California were mailed a study questionnaire. Participants were asked if they consider current published screening guidelines to be authoritative, reliable, and/or clinically appropriate. Clinical vignettes captured individual provider beliefs on timing and method of cervical cancer screening in women within the four key age groups embedded in current screening guidelines.
  
  
  RESULTS
  Of the 4,909 surveys mailed, 1,268 (25.8%) qualified responses were received. Fundamentally, 35.0% of all primary care providers do not believe current guidelines are clinically appropriate, with 58.6% of obstetrician/gynecologist physicians having this same skepticism. Even among those who affirmatively believe current guidelines are authoritative, reliable, and clinically appropriate, only 15.3% recommend screening intervals and methodology of testing in women of four differing ages consistent with that of current policy guidelines.
  
  
  CONCLUSIONS
  Among the primary care providers surveyed, distrust and confusion likely limit adherence to current evidence-based cervical cancer screening health policy recommendations, and contribute to the current high rates of overscreening that have been observed.
authors.affiliation: 1 Sol Price School of Public Policy, University of Southern California , Los Angeles, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Boone
authors.affiliation: 1 Sol Price School of Public Policy, University of Southern California , Los Angeles, California.
authors.forename: LaVonna
authors.initials: L
authors.lastname: Lewis
authors.affiliation: 2 Department of General Internal Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Karp
mesh_terms: D000328:Adult; D002140:California; D003221:Confusion; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006176:Gynecology; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009722:Nurse Practitioners; D009774:Obstetrics; D010821:Physicians, Family / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011897:Random Allocation; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*