CLINICAL DECISION-MAKING AND MAMMOGRAPHY REFERRAL

Background. Physician characteristics, practice/structural factors, an d patient characteristics have all been found to influence mammography referral. The relationship of a patient's advanced age and comorbidit y to the physician's decision has not received much attention. Methods . Community-based, primary care physicians (n = 132) in two medium-siz ed U.S. cities completed questionnaires. Results. Physicians report th at they refer nearly all (89%) of the women ages 50-64 in their practi ce, slightly fewer of those 65-74: (83%), but many fewer (57%) of thos e 80 and over. Foreign medical graduates and physicians who are not bo ard certified reported lower referral rates, and those who were reside ncy trained reported substantially lower rates for the oldest patient group. Common reasons for not referring included assuming a gynecologi st or another physician will make the referral, patient cost, comorbid ity, and type of encounter, i.e., whether the patient is being seen fo r an acute condition. However, the lowest rate of referral was associa ted with believing that the patient was too old to benefit from early detection. Conclusions. Results are discussed in terms of the debate a bout whether guidelines should be based on patient age or functional s tatus and the need to openly discuss and evaluate the decision rules b eing used. (C) 1996 Academic Press, Inc.