Making decisions about cancer screening when the guidelines are unclear orconflicting

OBJECTIVE Our purpose was to determine the factors involved in the cancer s creening decisions of family physicians in situations where the clinical pr actice guidelines are unclear or conflicting as opposed to when they are cl ear and uncontroversial. STUDY DESIGN We analyzed discussions with focus groups using a constant com parative approach. POPULATION A total of 73 family physicians in active practice participated in 10 focus groups (1 urban group and 1 rural group in each of 5 Canadian p rovinces). OUTCOME MEASURES Our main outcome measures were participants' perceptions r egarding cancer screening when the guidelines were unclear or conflicting. RESULTS We propose a model of the determinants of cancer screening decision making with regard to unclear and conflicting guidelines. This model is ro oted in the physician-patient relationship, and is an interactive process i nfluenced by patient factors (anxiety, expectations, and family history) an d physician factors (perception of guidelines, clinical practice experience , influence of colleagues, distinction between the screening styles of spec ialists and family physicians, and the amount of time and financial costs i nvolved in performing the maneuver). CONCLUSIONS Our model is unique, because it is embedded in the physician-pa tient relationship. Ultimately, a modified model could be used to design in terventions to assist with the implementation of preventive services guidel ines.