title: Knowledge of and Attitudes Toward Evidence-Based Guidelines for and Against Clinical Preventive Services: Results from a National Survey.
abstract: CONCLUSIONS
  Both the underuse and overuse of clinical preventive services relative to evidence-based guidelines are a public health concern. Informed consumers are an important foundation of many components of the Affordable Care Act, including coverage mandates for proven clinical preventive services recommended by the US Preventive Services Task Force. Across sociodemographic groups, however, knowledge of and positive attitudes toward evidence-based guidelines for preventive care are extremely low. Given the demonstrated low levels of consumers' knowledge of and trust in guidelines, coupled with their strong preference for involvement in preventive care decisions, better education and decision-making support for evidence-based preventive services are greatly needed.
  
  
  BACKGROUND
  Both the underuse and overuse of clinical preventive services are a serious public health problem. The goal of our study was to produce population-based national data that could assist in the design of communication strategies to increase knowledge of and positive attitudes toward evidence-based guidelines for clinical preventive services (including the US Preventive Services Task Force, USPSTF) and to reduce uncertainty among patients when guidelines change or are controversial.
  
  
  METHODS
  In late 2013 we implemented an Internet-based survey of a nationally representative sample of 2,529 adults via KnowledgePanel, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and those with less than a high school education were oversampled. We then conducted descriptive statistics and multivariable logistic regression analysis to identify the prevalence of and sociodemographic characteristics associated with key knowledge and attitudinal variables.
  
  
  RESULTS
  While 36.4% of adults reported knowing that the Affordable Care Act requires insurance companies to cover proven preventive services without cost sharing, only 7.7% had heard of the USPSTF. Approximately 1 in 3 (32.6%) reported trusting that a government task force would make fair guidelines for preventive services, and 38.2% believed that the government uses guidelines to ration health care. Most of the respondents endorsed the notion that research/scientific evidence and expert medical opinion are important for the creation of guidelines and that clinicians should follow guidelines based on evidence. But when presented with patient vignettes in which a physician made a guideline-based recommendation against a cancer-screening test, less than 10% believed that this recommendation alone, without further dialogue and/or the patient's own research, was sufficient to make such a decision.
  
  
  CONCLUSIONS
  Given these demonstrated low levels of knowledge and mistrust regarding guidelines, coupled with a strong preference for shared decision making, better consumer education and decision supports for evidence-based guidelines for clinical preventive services are greatly needed.
authors.affiliation: Gerald R. Ford School of Public Policy, University of Michigan.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.affiliation: Milken Institute School of Public Health, George Washington University.
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Evans
authors.affiliation: Milken Institute School of Public Health, George Washington University.
authors.forename: Holly
authors.initials: H
authors.lastname: Mead
authors.affiliation: School of Nursing, Johns Hopkins University.
authors.forename: Carmen
authors.initials: C
authors.lastname: Alvarez
authors.affiliation: Patient Centered Outcomes Research Institute.
authors.forename: Lisa
authors.initials: L
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003142:Communication; D054626:Consumer Health Information / Q000458:organization & administration* / Q000592:standards; D004522:Educational Status; D019317:Evidence-Based Medicine / Q000331:legislation & jurisprudence / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D007342:Insurance Benefits / Q000191:economics / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000592:standards*; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000331:legislation & jurisprudence / Q000592:standards*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: clinical preventive services; evidence-based guidelines; patient engagement; survey research