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Show Using the criteria above, we identified two hundred twenty physicians for whom a single published recommendation could be considered the source that had influenced their practice patterns most (Table 7); the remainder rated more than one source equally high, rated one source high and wrote in a different source, or rated highest a source other than a published recommendation. The most frequently cited published recommendation was ACS (31.4%), followed by USPSTF (24.5%) and ACOG (23.2%). As in the total group of respondents, each specialty was more likely than the other two to cite its own recommendation. For instance, 28 family physicians but no internists or obstetrician-gynecologists considered A AFP their most important source. Of the 220 physicians, only 84 respondents (38.2%) indicated their own specialty recommendation. Only 26.7% of family physicians and 21.8% of internists but 73.3% of obstetrician-gynecologists cited their own specialty recommendation as the most important source. To determine the extent that physicians follow recommendations they cite as important influences on their practices, we compared the reported screening practices of these physicians to the recommendation they cited (Table 8). The following example illustrates how to interpret the table. We identified 28 physicians who considered AAFP to be the published recommendation that influenced their screening practices most. Although in low-risk patients AAFP recommends beginning mammography at age 50, screening every 1-2 years and stopping at age 69, 14.3% of these 28 physicians begin at age 50, 21.4% stop by age 75, and 17.9% specifically state an interval of 1-2 years. AAFP recommends beginning CBE at age 50, screening every 1-2 years, and stopping at age 69; however only 7.1% start after age 40, only 3.6% stop before age 75, and only 14.3% screen at an interval less frequent than 1 year. AAFP does not offer a recommendation for BSE, but all 28 physicians state that they recommend BSE, and all begin before age 40. Analysis of the data in Table 8 reveals that regardless of the published recommendation physicians consider to have influenced their screening practices most, a common practice pattern is evident. A majority of physicians begin mammography between ages 40-49 in low-risk women and before age 40 in high-risk women. Most physicians report that they stop mammography after age 75 or that they never stop. Many physicians did not indicate the interval between mammosrams so these data are less reliable, but the numbers available suggest physicians either screen every year or every 2 years. For CBE, most physicians begin before age 30, although physicians who cited ACP (which recommends starting at age 50) tend to start later. Most stop CBE after age 75 or never stop. Nearly each of the respondents recommend yearly CBE. For BSE, most recommend starting before age 30, and stopping after age 75 or never stopping. The above screening practices appear to reflect the recommendations of ACOG and ACS. Discussion The findings of this study demonstrate that physicians rely on many sources of information besides published recommendations, including personal review of original literature, personal experiences, expert opinions and discussions with their own patients. In many cases, physicians said that personal experiences influenced their recommendations more than research data did. Overall, almost half of the physicians stated that published recommendations influenced their practices most of all. As expected, physicians stated that they follow the recommendations of their specialty society. However, reported practice patterns showed otherwise. This study found that regardless of the recommendation cited, a common practice pattern was evident, which seemed to mirror recommendations by ACS and ACOG. For mammography, the majority of physicians started between ages 40-49, stopped late in the patient's life or not at all, and recommended an interval of either 1 or 2 years in ages 40-49 and of every year above age 50. These practices are consistent with ACS and ACOG recommendations. For CBE, the majority started between ages 18-29, stopped late in the patient's life or not at all, and recommended an interval of 1 year. These practices are consistent with ACOG recommendations. For BSE, the majority started between ages 18-29, stopped late in the patient's life, or not at all, and recommended an interval of 1 month. These practices are consistent with ACS and ACOG recommendations. Additionally, although AAFP, ACP and USPFTF do not recommend BSE, nearly all physicians who cited each of these recommendations stated that they recommend BSE to their patients. Several possible explanations for this common pattern exist. Physicians may believe they are following a specific recommendation, then the recom- 36 Utah's Health: An Annual Review Volume VIII |
