Primary care physicians' judgments of multiple clinical practice guidelines for breast and cervical cancer screening: Results from a national survey

Background: Multiple clinical practice guidelines (CPG) exist for breast and cervical cancer screening, and require physicians to judge their value and make clinical decisions in response. However, little is known about these processes. This study describes U.S. primary care physicians' (PCP) judgments of different CPG for breast and cervical cancer screening, and examines potential predictors and outcomes of these judgments.

Methods: A 2006-2007 national survey of PCPs collected information on their judgments of breast and cervical cancer screening guidelines from five professional organizations; physician and practice characteristics; and cancer screening recommendations based on clinical vignettes. Descriptive and multivariate logistic regression analyses were conducted to characterize: 1) PCPs' judgments of the influence of different CPG; 2) factors associated with these judgments; and 3) the relationship of CPG judgments with the aggressiveness of PCPs' cancer screening recommendations.

Results: American Cancer Society and American College of Obstetrics and Gynecology guidelines for cancer screening were perceived as more influential than other organizations' guidelines. However, most physicians (62%) judged multiple guidelines as very influential, and endorsed guideline combinations that were more often conflicting or aggressive than conservative in their screening recommendations. Specialty was the strongest of several significant predictors of guideline judgments; OB/GYNs valued more aggressive guideline combinations than other physicians (p<.001). The guideline(s) judged most influential corresponded to the aggressiveness of PCPs' screening recommendations (p<.01).

Conclusions: U.S. PCPs' judgments of different breast and cervical cancer screening guidelines vary, are related to specialty and other factors, and are associated with the aggressiveness of screening recommendations.