There are more clinical practice guidelines available to physicians
than for any other medical procedure for breast cancer screening. A
new study in the Journal for Healthcare Quality reports that when
different clinical guidelines exist, physicians choose recommendations
from multiple, sometimes conflicting, sources. Research analysts with
the American College of Obstetricians and Gynecologists assessed ob-gyn
physicians’ use of multiple guidelines following issuance in 2009 of
breast cancer screening recommendations by the U.S. Preventative
Services Task Force. The Task Force guideline stated that physicians
should not routinely recommend annual breast cancer screening for women
under the age of 50 but, instead, allow them to make their own
independent decisions. These recommendations contradict guidelines
published by ACOG and the American Cancer Society (ACS), which call for
annual breast cancer screening beginning at age 40. In 2009, ACOG
recommended breast cancer checks every two years but revised its
recommendation in 2011 to advocate annual screening.
The ACOG researchers surveyed 224 ob-gyns to investigate how they
utilize multiple breast cancer screening guidelines and evaluate the
impact of the 2009 USPSTF recommendations on their practices. Results
showed that 83.5 percent of the physicians surveyed said they were
influenced by more than one breast cancer screening guideline, and 42
percent reported making at least one practice change after release of
the USPSTF recommendations. Seventeen percent said they were influenced
by the USPSTF recommendations and 73 percent were influenced by the ACOG
and ACS guidelines.
Other key findings of the study found that:
• Physicians agree with multiple breast cancer screening guidelines that sometimes conflict
• Individual recommendations are followed from multiple guidelines
• Doctors who follow conflicting guidelines tend to practice more conservatively
• Practices changed after the USPSTF guidelines and the most common
change was discussing pros and cons of mammography before recommending
it for women under 50.
The authors explained that existence of multiple guidelines can cause
doctors to avoid using them, but evidence in this study refutes that
assertion as 84 percent of physicians said they were influenced by two
or more guidelines for breast cancer screening.
The study also showed doctors will not accept new guidelines based on
their opinion of the guideline-issuing organization alone, but make
practice decisions from individual recommendation statements.
What is the Journal for Health care Quality?
The Journal for Healthcare Quality (JHQ) is the first choice for
creative and scientific solutions in the pursuit of healthcare
quality. JHQ is peer reviewed and published six times a year. It
publishes scholarly articles targeted to leaders of all healthcare
settings, leveraging applied research and producing practical, timely,
and impactful evidence in healthcare system transformation covering
topics in: quality improvement, patient safety, performance measurement,
best practices in clinical and operational processes, innovation,
leadership, information technology, spreading improvement, sustaining
improvement, cost reduction, and payment reform.
About NAHQ
The National Association for Healthcare Quality was founded in 1976
and covers a full spectrum of healthcare specialties. The NAHQ is an
essential and interactive resource for quality and patient safety
professionals worldwide. NAHQ’s vision is to realize the promise of
healthcare improvement through innovative practices in quality and
patient safety. NAHQ’s 12,000-plus members benefit from cutting edge
education and NAHQ’s unique collective body of knowledge, as well as
opportunities to learn from a diverse group of professionals. These
resources help assure success for implementing improvements in quality
outcomes and patient safety, navigating the changing healthcare
landscape, and serving as the voice of quality.
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