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Making Decisions About Cancer Screening When the Guidelines Are Unclear or Conflicting

The Journal of Family Practice. 2001 August;50(08):682-687
August 1, 2001|The Journal of Family Practice
Fred Tudiver, MD
Author and Disclosure Information

Fred Tudiver, MD
Judith Belle Brown, PhD
Wendy Medved
Carol Herbert, MD
Paul Ritvo, PhD
Remi Guibert, MD
Jeannie Haggerty, PhD
Vivek Goel, MD
Philip Smith, PhD
Maeve O’ Beirne, MD, PhD
Alan Katz, MD
Peter Moliner, MD
Antonio Ciampi, PhD
Ivan J. Williams, PhD
Syracuse, New York; London, Toronto, Montreal, Prince Edward Island, Edmonton, and Manitoba, Canada; and Melbourne, Australia
Submitted, March 28, 2001.
From the State University of New York Upstate Medical University, Syracuse (F.T.); the University of Western Ontario, London (J.B.B., C.H.); the University of Toronto (W.M., P.R., V.G., J.I.W.); the Monash University, Melbourne (R.G.); the University of Montreal (J.H.); the University of Prince Edward Island (P.S.); the University of Alberta, Edmonton (M.O.); the University of Manitoba (A.K.); and McGill University, Montreal (P.M., A.C.). Reprint requests should be addressed to Fred Tudiver, MD, Suite 200, 475 Irving Ave, Syracuse, NY 13210. E-mail: tudiverf@upstate.edu.

Future Research

In the next phase of our study we will test the model’s factors quantitatively on a random sample of physicians and go through the same steps with a patient/consumer sample. Ultimately, we will use a modified model to design interventions to assist with the implementation of preventive services guidelines.

Conclusions

Our findings are of importance for those implementing preventive care guidelines. The focus group participants were clearly less happy with guidelines that were equivocal, and were less likely to follow them. Patient factors and the physician-patient relationship appear to be important in such cases. Although patient-oriented decision aids could help physicians in these situations, it is clearly more difficult to develop aids to guide patients in settings when the evidence is unclear, because the information required is more complex. The family physicians’ perceptions of the effectiveness of a particular screening test was very important, perhaps more important to the participants than the scientific evidence behind a guideline. Although personal experience is a weak and unscientific level of evidence subject to many biases, it is likely an important influence on cancer screening decision making in primary care, particularly when the evidence is uncertain. Future education efforts directed at primary care providers should address the influence of personal experience as well as the failure to attend to the level of evidence behind recommendations.

Acknowledgments

Our project was funded by a peer-reviewed grant from the Medical Research Council of Canada (grant number 14673) and by the Prince Edward Island Cancer Research Council. We wish to thank the staff of the Department of Family and Community Medicine, University of Toronto, for their tireless support of this project.

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