For breast cancer screening, there are more clinical practice guidelines available to physicians than for any other medical procedure. A new study in the Journal for Healthcare Quality reports that when different clinical guidelines exist, physicians choose recommendations from multiple, sometimes conflicting, sources. JHQ is the peer reviewed publication of the National Association for Healthcare Quality (NAHQ, www.nahq.org).
Research analysts with the American College of Obstetricians and Gynecologists (ACOG) 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 (USPSTF). The USPSTF 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. Physicians were asked to answer survey questions asking how much the various guidelines influence their practices and whether they agreed with the USPSTF recommendations. They also were asked to identify specific recommendations endorsed by USPSTF and ACOG.
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 are:
•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. "Physicians ultimately decide which parts of each of the guidelines they agree with and follow, but this complicates use of any guideline as the standard of practice in litigation or other settings," the authors noted.
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