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Show November 2000 issued a press release to reaffirm their stance (1998). The American Medical Association (AMA) published its recommendations in 1989 and adopted an update in 1999 (1999). The Canadian Task Force on Preventive Health Care (CTFPHC, 2001) reworded its 1994 recommendations in 1998 (Temple, 1999), and updated its recommendations in 2001 (Baxter, 2001; Ringash, 2001). The National Cancer Institute (NCI) updated its recommendations in January 2001 (2001). The Institute for Clinical Systems Improvement (ICSI) 1998 recommendation was updated January 2000, and again in October-November 2001, with updates expected every 18 months (2001). United States Preventive Services Task Force (USPFTF) published its recommendations in 1996, with an update expected in 2002 (1996). In addition to recommendations in the published literature, physicians may rely on other information, such as HMO guidelines, local experts, colleagues, public opinion and personal experience. The extent to which physicians rely on each of these sources of information to form their individual screening practices is not known. We designed this study to test the hypotheses that physicians rely on numerous resources besides published guidelines to determine their breast cancer screening practices, and that although screening practices vary by individual, physicians within a given specialty tend to follow the recommendations of their specialty society. Methods From the Utah State Department of Commerce, Division of Professional Licensure we obtained a list of physicians practicing in Utah in the spring of 2000. After obtaining these physicians' medical specialties from a directory of the Utah Medical Association, we sent questionnaires to 1,018 family physicians, internists, and obstetrician-gynecologists. Of those who responded, 71 physicians indicated that they did not provide primary care to women older than age 30, leaving 947 total physicians eligible to participate in the study. Physicians were ineligible to participate if they indicated on the survey that they did not provide primary care to women older than age 30, or if they were both board certified in a sub-specialty and lived in one of the five urban counties in Utah (Salt Lake, Utah, Weber, Davis, Washington). We designed the latter criterion to exclude physicians who do not screen for breast cancer, but to include subspecialists in less urban counties who may include primary care in their practice. The questionnaire asked for demographic information, current screening practices, and sources of information that physicians used to formulate their screening practices (see Appendix). Continuous data were analyzed with ANOVA or t-tests and categorical data were analyzed with yj tests using the SAS statistical software package. Results Three hundred sixty-seven physicians (198 family physicians, 89 internists and 80 obstetrician-gynecologists) of 947 total physicians responded to the survey, for a response rate of 38.8%. The characteristics of respondents are listed in Table 2. Sources of Information Physicians rated each of 12 sources on a 7-point scale to indicate the extent they thought each source influenced their screening practices. We analyzed the results using pair-wise comparisons of means (Table 3). Family physicians were more likely than internists or obstetrician-gynecologists to rate the American Academy of Family Physicians (AAFP) highly (p<0.0001). Obstetrician-gynecologists were more likely than family physicians or internists to rate ACOG highly (p<0.0001). Internists were more likely than family physicians or obstetrician-gynecologists to rate the American College of Physicians (ACP) (p<0.0001) and the American Medical Association (AMA) (p<0.02) highly. Obstetrician-gynecologists were least likely to rate the United States Preventive Services Task Force (USPSTF) highly (p<0.0001). There were no statistically significant differences between specialties in rating ACS, colleagues, HMO guidelines, local experts, personal experience, personal review of literature, or public opinion. Among the 56 respondents who cited a local expert as an important source of information, 29 said they consult surgeons, 14 said they consult obstetrician-gynecologists, 11 said they consult oncologists, and 2 said they consult radiologists. In addition to the sources listed on the survey, respondents cited the following sources: fear of lawsuit (n=4), American College of Radiology (n=2), American College of Female Radiologists (n=l), American College of Surgeons (n=l), American Geriatric Society (n=l), Gothenburg trial (n=l), and Institute for Clinical Systems Improvement (n=l). Anticipating that physicians might rate more than one source highest, we also asked physicians to Utah's Health: An Annual Review Volume VIII 29 |