Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results.

Autor: Dang TH; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Rieu-Werden ML; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Kobrin SC; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA., Tiro JA; Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL, USA., Werner C; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Parkland Health and Hospital System, Dallas, TX, USA., Lykken JM; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA., Chubak J; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Atlas SJ; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Higashi RT; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA., Lee SC; Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA., Haas JS; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Skinner CS; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA., Silver MI; Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Feldman S; Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. sfeldman@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Jul 25. Date of Electronic Publication: 2024 Jul 25.
DOI: 10.1007/s11606-024-08943-z
Abstrakt: Background: Guidelines for managing abnormal cervical cancer screening results are complex and adherence is challenging for clinicians. Previous studies have identified gaps in knowledge as a possible cause; few have explored the confidence clinicians have in their management decisions. Confidence in decision-making may influence management practices, particularly when guidelines are complex and evolving.
Objective: Assess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results.
Design: A clinician survey used vignettes to ask clinicians to make a management recommendation for different abnormal results and rate their level of confidence in their response.
Participants: Physicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts.
Main Measures: Correct response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines.
Key Results: In total, 501 clinicians completed the survey between October and December 2020 (response rate 53.7%). Overall, most clinicians made guideline-recommended management decisions for two vignettes (73.2 and 73.7%), but fewer were confident in their selection (48.3% and 46.6%, respectively). Clinicians who reported high levels of confidence were more often correct than those who reported lower levels of confidence (85.8% vs. 62.2% and 87.5% vs. 60.7%, both p<0.001). After adjusting for clinician and practice characteristics, confidence remained significantly associated with selecting the correct answer.
Conclusions: Clinician confidence in management decisions for abnormal cervical cancer screening results was significantly associated with knowing guideline-concordant recommendations. Given the complexity of cervical cancer management guidelines, solutions to improve clinician confidence in decision-making are needed.
(© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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