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Show Appendix: Physician Screening Practices Questionnaire 1. What is your gender? Female Male 2. How long have you been in practice? 3. Do you provide primary care to women age 30 or older? No: Please stop now and return this survey in the envelope provided. Yes: __________________number/week 4. For each of the screening tests in the table below, please indicate the following: 1. At what age do you recommend beginning screening? 2. At what age do you recommend stopping screening? 3. At what interval do you recommend repeated screening? Low Risk Patients 1 Start age Stop age Screening interval High Risk Patients 1 Start age 2 3 Stop age Screening interval Marnrnography Clinical breast exam Self breast exam Mammography Clinical breast exam Self breast exam 5. To what extent do you base your screening practices on each of the following sources: Clinical guidelines NOT AT ALL American Academy of Family Physicians (AAFP). American Cancer Society (ACS) ..... American College of Obstetricians & Gynecologists (ACOG) American College of Physicians (ACP) .... American Medical Association (AMA) .... U.S. Preventive Services Task Force (USPSTF). Other guideline:________________________________. Colleague ......... HMO guidelines......... Local expert......... What specialty is the expert?_____________________________ Personal experience Personal review of literature Public opinion Other:____________________ VERY MUCH 5 6 7 6 3 4 5 3 4 5 3 4 5 3 4 5 5 6 7 5 6 7 5 6 7 6 7 6 7 6 7 6 7 6. What source of information has influenced your screening practices the most? Please indicate if you would like to be informed of the results of the study. 34 Utah's Health: An Annual Review Volume VIII |