What influences family physicians' XXXX screening decisions when practice guidelines are unclear or conflicting?

@entity5 @entity1 @entity148
OBJECTIVES: To determine (a) the respondents' perceptions of 4 unclear or conflicting @entity5 screening guidelines: prostate-specific antigen (PSA) for @entity1 over 50, mammography for @entity1 40-49, colorectal screening by fecal occult blood testing (FOBT), and colonoscopy for @entity1 over 40; and (b) the influence of various factors on the decision to order these tests. STUDY DESIGN: National Canadian mail survey of randomly selected family physicians. POPULATION: Family physicians in active practice (n=565) selected from rural and urban family medicine sites in 5 provinces representing the main regions in Canada. OUTCOME MEASURED: Agreement with guideline statements, and decision to order screening test in 6 clinical vignettes. RESULTS: Of 565 surveys mailed, 351 (62.1%) were returned. Most respondents agreed with the Canadian Task Force recommendations, and most believed that various guidelines for 3 of the 4 screens were conflicting (PSA 86.6%; mammography 67.5%; FOBT 62.4%). @entity1 @entity148 about @entity5 , @entity1 expectations of being tested, and a positive family history of @entity5 increased the odds that the 4 tests would be ordered. A good quality @entity1 -MD relationship decreased the odds of ordering a mammogram. Screening decisions were also significantly influenced by the respondents' beliefs about whether screening was recommended and whether screening could cause more harm than good. A physician's sensitivity to his or her colleagues' practice influenced screening decisions regarding PSA and mammography. CONCLUSIONS: These results suggest a conceptual framework for understanding the determinants of screening behavior when guidelines are unclear or conflicting.
