Physicians’ Beliefs About Breast Cancer Surveillance Testing are Consistent With Test Overuse

Bibliographic Data

ID9098934
AuthorsPaul K J Han (0000-0003-0165-1940, Tufts University, corresponding author), Carrie N Klabunde (Applied Research Associates), Anne-Michelle Noone, Anne‐Michelle Noone (0000-0001-6997-4004, Center for Surveillance, Epidemiology, and Laboratory Services), Craig C Earle (0000-0002-0420-1999, Ontario Institute for Cancer Research), John Z Ayanian (Harvard University), Patricia A Ganz (0000-0002-1841-4143, UCLA Health), Katherine S Virgo (0000-0002-2069-0585, American Cancer Society, corresponding author), Arnold L Potosky (0000-0001-8087-6667, Georgetown University Medical Center)
Year2013
Volume51
Issue4
Pages315-323
Publication date2013-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31827da908
PMID23269111
PMCIDPMC3596481
OpenAlexW2067132339
LanguageEN
Citations received3
References cited43

BACKGROUND: Overuse of surveillance testing for breast cancer survivors is an important problem but its extent and determinants are incompletely understood. The objectives of this study were to determine the extent to which physicians' breast cancer surveillance testing beliefs are consistent with test overuse, and to identify factors associated with these beliefs. METHODS: During 2009-2010, a cross-sectional survey of US medical oncologists and primary care physicians (PCPs) was carried out. Physicians responded to a clinical vignette ascertaining beliefs about appropriate breast cancer surveillance testing. Multivariable analyses examined the extent to which test beliefs were consistent with overuse and associated with physician and practice characteristics and physician perceptions, attitudes, and practices. RESULTS: A total of 1098 medical oncologists and 980 PCPs completed the survey (response rate 57.5%). Eighty-four percent of PCPs [95% confidence interval (CI), 81.4%-86.5%] and 72% of oncologists (95% CI, 69.8%-74.7%) reported beliefs consistent with blood test overuse, whereas 50% of PCPs (95% CI, 47.3%-53.8%) and 27% of oncologists (95% CI, 23.9%-29.3%) reported beliefs consistent with imaging test overuse. Among PCPs, factors associated with these beliefs included smaller practice size, lower patient volume, and practice ownership. Among oncologists, factors included older age, international medical graduate status, lower self-efficacy (confidence in knowledge), and greater perceptions of ambiguity (conflicting expert recommendations) regarding survivorship care. CONCLUSIONS: Beliefs consistent with breast cancer surveillance test overuse are common, greater for PCPs and blood tests than for oncologists and imaging tests, and associated with practice characteristics and perceived self-efficacy and ambiguity about testing. These results suggest modifiable targets for efforts to reduce surveillance test overuse

Breast cancer · Cancer · Confidence interval · Cross-sectional study · Family medicine · Mammography · MEDLINE · Pathology · Test (biology) · Vignette · Economic and Financial Impacts of Cancer · Global Cancer Incidence and Screening · Healthcare cost, quality, practices · Internal Medicine · Medicine

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