USE OF SCREENING MAMMOGRAPHY BY GENERAL INTERNISTS

While physician endorsement has been shown to be highly important in m otivating women to obtain screening mammograms, there is evidence that doctors do not refer women for the procedure as often as they should. The objective of this study was to help understand why physicians do not routinely utilize screening mammography. Randomly selected Washing ton State general internists were surveyed by mail, concerning mammogr aphy, during 1989. An expanded theory of reasoned action was used as a broad conceptual framework for considering factors potentially associ ated with use. The survey response rate was 66%, yielding a study samp le of 85. Only 38% of the respondents reported they always ordered mam mograms for women aged 50 years and over during preventive office visi ts. Nearly half (43%) had no reminder system for the test. Correlates of use included beliefs concerning the screening behavior of other doc tors, the location of mammography facilities in relation to physician offices, and age. Physician-related barriers, such as doubts about eff ectiveness, were found to affect use more than patient-related barrier s, such as cost. The recommendations of professional organizations wer e shown to have been important in influencing physician use of screeni ng mammography. This study indicates a proportion of general internist s are not routinely ordering mammograms for their age-eligible female patients. The findings identify barriers to use of mammography that ne ed to be overcome if national efforts to promote use of the procedure by primary care physicians are to succeed. Implications for interventi on are reviewed.