Measuring and predicting surgeons' practice styles for breast cancer treatment in older women

BACKGROUND. Few measures exist to assess physicians' practice style, and th ere are few data on physicians' practice styles and patterns of care. OBJECTIVES. TO use clinical vignettes to measure surgeons' "propensity" for local treatments for early-stage breast cancer and to describe factors ass ociated with propensity. RESEARCH DESIGN AND SUBJECTS. A cross-sectional mailed survey with telephon e follow-up of a random sample of 1,000 surgeons treating Medicare benefici aries in fee-for-service settings. MEASURES. Outcome measures include treatment propensity, self-reported prac tice, and actual treatment received by the surgeons' patients. RESULTS. Pro pensities were significantly associated with actual treatment, controlling for covariates, Area Medicare fees were the strongest predictor of propensi ty, followed by region, attitudes, volume, and gender. For instance, after other factors were considered, surgeons practicing in areas with the highes t breast-conserving surgery (BCS) fees were 8.61 (95% CI2.26-32.73) times m ore likely to have a BCS propensity than surgeons in areas with the lowest fees. Surgeons with the strongest beliefs in patient participation in treat ment decisions were nearly 6 times (95% CI 1.67-20.84) more likely to have a BCS propensity than surgeons with the lowest such beliefs, controlling fo r covariates, Male surgeons were also independently more likely to have a m astectomy propensity than female surgeons. CONCLUSIONS. Surgeons' propensities explain some of the observed variations in breast cancer treatment patterns among older women, Standardized scenar ios provide a practical method to measure practice style and could be used to evaluate physician contributions to shared decision making, practice pat terns, costs and outcomes, and adherence to guidelines.