Implementation of cancer prevention guidelines in clinical practice Authors
Diffusion Of Task Force Recommendations
Cite this article as: McPhee, S.J. & Bird, J.A. J Gen Intern Med (1990) 5: S116. doi:10.1007/BF02600856 Abstract
Data from several sources, including consumer surveys, physician surveys, and medical record audits, indicate that consumers do not receive cancer screening tests as recommended by the National Cancer Institute, the American Cancer Society, and the U.S. Preventive Services Task Force. Performance rates are consistently below published standards for all tests except Pap tests. Major reasons physicians do not perform the recommended tests include physician forgetfulness, disagreement with recommendations, lack of time, and patient refusal. Physicians also tend to overestimate their own performance rates. Barriers to screening test performance can be categorized into patient factors, physician factors, test factors, and health care delivery system factors. Interventions, such as computerized reminder systems, physician audits with feedback, and patient education and reminders, can be effective in promoting performance of such screening. Interventions that target both physician and patient may be particularly effective.
Key words cancer mass screening reminder systems barriers physician practice patterns
Presented at the conference, Frontiers in Disease Prevention, The Johns Hopkins University, June 5–6, 1989.
Supported by grants CCG 5 R01 CA37340 and SRC (68) 5 R01 CA46020 from the National Cancer Institute, Department of Health and Human Services.
American Cancer Society. Cancer statistics, 1988. CA. 1988;38:5–22.
Tabar L, Fagerberg CJG, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography: randomized trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985;1:829–32.
McPhee SJ, Jenkins CN, Bird JA. Screening for colorectal cancer: an annotated bibliography for clinicians and educators. J Cancer Educ. Part I. 1987;2:35–49; and Part II. 1987;2:113–27.
Knight KK, Fielding JE, Battista RN. Occult blood screening for colorectal cancer. JAMA. 1989;261:586–93.
Laara E, Day NE, Hakama M. Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet. 1987 (May 30):1247–9.
U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. Baltimore: Williams and Wilkins, 1989.
National Cancer Institute. Working guidelines for early cancer detection: rationale and supporting evidence to decrease mortality. Bethesda, MD: Early Detection Branch, Division of Cancer Prevention and Control, National Cancer Institute, 1987.
American Cancer Society. Summary of current guidelines for the cancer-related check-up: recommendations. New York: ACS, 1988.
National Center for Health Statistics and National Cancer Institute. Provisional estimates from the National Health Interview Survey Supplement on Cancer Control—United States—January–March, 1987. MMWR. 1988;37:417–25.
McPhee SJ, Richard RJ, Solkowitz SN. Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society guidelines. J Gen Intern Med. 1986;1:275–81.
Battista RN. Adult cancer prevention in primary care: patterns of practice in Quebec. Am J Public Health. 1983;73:1036–9.
American Cancer Society. Survey of physicians’ attitudes and practices in early cancer detection. CA. 1985;35:197–213.
Romm FJ, Fletcher SW, Hulka BS. The periodic health examination: comparison of recommendations and internists’ performance. South Med J. 1981;74:265–71.
Woo B, Woo B, Cook EF, et al. Screening procedures in the asymptomatic adult. Comparison of physicians’ recommendations, patients’ desires, published guidelines, and actual practice. JAMA. 1985;254:1480–4.
Lewis CE. Disease prevention and health promotion practices of primary care physicians in the United States. Am J Prev Med. 1988;4(4):s9–16.
Makuc DM, Freid VM, Kleinman JC. National trends in the use of preventive care by women. Am J Public Health. 1989;79:21–6.
Gemson DH, Elinson J. Prevention in primary care: variability in physician practice patterns in New York City. Am J Prev Med. 1986;2:226–34.
Gemson DH, Elinson J, Messeri P. Differences in physician prevention practice patterns for white and minority patients. J Community Health. 1988;13(1):53–64.
Burack RC, Liang J. The early detection of cancer in the primary care setting: factors associated with the acceptance and completion of recommended procedures. Prev Med. 1987;16:739–51.
Lurie N, Manning WG, Peterson C, et al. Preventive care: do we practice what we preach? Am J Public Health. 1987;77:801–4.
Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988;259:2872–4.
Orlandi MA. Promoting health and preventing disease in health care settings: an analysis of the barriers. Prev Med. 1987;16:119–30.
Green LW, Eriksen MP, Schor EL. Preventive practices by physicians: behavioral determinants and potential interventions. Am J Prev Med. 1988;4(4):s101–7.
Sickles EA, Weber WN, Galvin HB, Ominsky SH, Sollitto RA. Mammographic screening: how to operate successfully at low cost. Radiology. 1986;160:95–7.
McPhee SJ, Bird JA, Jenkins CN, Fordham D. Promoting cancer screening: a randomized, controlled trial of three strategies. Arch Intern Med. 1989;149:1866–72.
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