Performance of cancer screening in a university general internal medicine practice

Abstract

The authors evaluated use of seven cancer screening tests by 52 providers in a university general internal medicine practice, using 1980 American Cancer Society (ACS) recommendations as standards for comparison. Performance rates were determined by retrospective medical record reviews of a stratified random sample of 525 patients. In addition, the 48 physicians and four nurse-practitioners in the practice were interviewed to determine their opinions, knowledge and perceived use of the tests. Performance rates were low, significantly below the ACS guidelines for all tests except Pap smear. Providers used the tests significantly more often to evaluate patients with cancer risk factors or for new patients. They significantly overestimated their own performances of six tests. More than a fourth of the providers disagreed with the use of mammography, sigmoidoscopy, pelvic or rectal examinations for screening asymptomatic adults. Their knowledge about cancer screening and the ACS recommendations was highly variable, and frequently quite limited. Providers offered four major reasons for not performing the screening tests: provider forgetfulness, lack of time, inconvenience and logistical difficulties, and patient discomfort or refusal.

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

“…Many of the studies published to date were not truly population based (McPhee et al, 1986;McCarthy and Bore, 1991;Studnicki et al, 1993;Grimshaw et al, 1995). Most studies did not compare practice patterns in centres with and without guidelines and therefore, even if guideline compliance was observed, it has not been possible to distinguish between true effects of treatment guidelines and general physician knowledge of good medical practice that may be adopted irrespective of the existence of treatment guidelines.…”

“…Several treatment guidelines for adjuvant systemic therapy for NNBC have been developed and distributed, but the actual impact of these guidelines on consistency of care is uncertain. In the few studies to date, the impact of treatment guidelines on patterns of breast cancer care has been modest, if detectable at all (McPhee et al, 1986;Ford et al, 1987;Gregorio et al, 1990;Grilli et al, 1991;McCarthy and Bore, 1991). The majority of these reports evaluated the influence of guidelines at a circumscribed level such as the hospital or university; very few have examined the impact of treatment guidelines at the level of the entire population.…”

What can we generalize from research on patient education and clinical health promotion to physician counseling on diet?

“…Now, even primary care physicians have dif®culty devoting much time, attention, or effort to the education of their patients about behavioral risk factors and ways to modify them (Wechsler et al, 1983;McAlister et al, 1985;Nutting, 1986;Gottlieb et al, 1987;Hiddink et al, 1997). Studies have found large discrepancies among physician initiatives, patient expectations, and published guidelines (Anda et al, 1987;McPhee et al, 1986;Romm et al, 1981;Wells et al, 1986;Woo et al, 1985;Singer et al, 1991).…”

Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

“…[21][22][23][24] Accordingly, the primary objective of this study was to explore physicians' barriers of and facilitators to recommendation of CRCS. In contrast to previous studies of physician recommendation of screening, which have relied either on physician self-report which overestimates true rates, 25,26 or chart abstraction, which is limited by recording bias, 27 this study used a triangulation of qualitative methods that included in-depth interviews, chart-stimulated recall, and focus groups.…”