Table 4 Factors guiding primary care physicians in the decision-making process regarding mammography screening with average-risk women

Tudiver 2002

• Patient anxiety, patient expectations of being tested, and a positive family history of breast cancer all significantly increased the chances that a mammogram would be ordered.

• MDs’ beliefs that mammography was not recommended or causes more harm than good, and a good patient-doctor relationship decreased the odds of screening.

• The sensitivity of MDs to their colleagues’ practice increased the odds of screening.

Haggerty 2005

• The physicians who believed routine screening was recommended ordered the test in most cases regardless of patient characteristics.

• Physician beliefs about screening strongly predicted test ordering, but only when patients had no anxiety or expectations. If a physician thought that mammography for women aged 40 to 49 was not recommended or was unclear, then a patient’s expectation of having mammography tripled the probability that mammography would be ordered.

• If a physician perceived that routine mammography was recommended, however, then a patient’s expectation did not alter significantly the already high likelihood that a physician would order the mammography test.

• Family physicians agreed that numerous non-medical factors influenced their usual test-ordering behavior.

• 89.6% of physicians stated they would order a screening test that they would not usually recommend if the specialists with whom they work recommended the test

• 88.1% would order the test if a patient requested the test and insisted on having it done.

• 87% would order it if a patient was anxious about having the disease.

• 59.2, 57.2, and 54.7% of physicians would order the test if it was easy to administer, easily accessible, and inexpensive, respectively.

• If their colleagues were recommending the test to their own patients, 37% of physicians said they would order the test.

• Approximately 30% of physicians said they would order the test if it would take less time than convincing patients that they do not need it.

Meissner 2011

• Most physicians identified at least 1 breast cancer screening guideline as being very influential in their practice.

• The ACS guidelines were most frequently cited as influential (56%), followed by the ACOG (47%), USPSTF (42%), AAFP (32%), and ACP (25%) guidelines.

Smith 2012

• 40% of physicians did not think breast cancer screening was necessary for women aged 40 to 49, but 62% said they would order the test if their patients requested it.

• Reasons to not offer screening:

   - No evidence of decreasing breast cancer related deaths (63%)

   - Grade A recommendation to screening at age 50 and not 40 (25%)

   - Harms of screening outweighing benefits (19%)

• Reasons to offer screening:

   - Patient request (55%)

   - Personal practice or mentor recommendation (27%)

   - Guideline recommendation (18%)

   - Other reasons to offer screening included emerging evidence of a modest decrease in breast cancer mortality, detection of early-stage breast cancer, and improvement in imaging for detecting benign versus malignant lumps.

Miller 2014

• The majority of physicians ranked their respective specialty professional organization as one of the top organizations that influenced their cancer screening recommendations.

• Across all three specialties, the majority of physicians reported the ACS as a top influential organization.

• More than 50% of Family Medicine and Internal Medicine physicians reported the USPSTF, as their top influential organizations.

• Almost 50% of the Obstetrics and Gynecology physicians ranked the National Institutes of Health/National Cancer Institute as one of their top influential organizations.

• Physicians who listed the ACS as one of their top influential organization were significantly more likely to believe that mammography was effective for women 40–49.

• In contrast, physicians who listed the USPSTF as their top influential guideline were less likely to believe that mammography was effective for women age 40–49.

• Physicians who reported a personal cancer experience were less likely to believe that mammography is effective for women aged 50–69 years.

Kiyang 2015

NA^a

DuBenske 2017

• Physicians report concerns for time constraints and desire for efficiency in decision-making discussions.

• Women identify the need for physicians to take time to listen to their concerns and answer questions (reported as a discordance with the finding from the physician interviews).

Radhakrishnan 2017

• Physicians who trusted ACS and ACOG were significantly more likely to recommend screening to younger women compared with those who trusted USPSTF guidelines.

Radhakrishnan 2018

• 26% of physicians trusted ACOG guidelines the most, 23.7% ACS, and 22.9% UPSTF.

• The most trusted guidelines for gynecologists, family medicine/general practitioners, and internists were respectively those by ACOG, USPSTF, and ACS.

• Factors leading to physicians recommending screening:

   (1) Physicians had feelings of potential regret from not ordering mammograms:

      - Higher risk for malpractice liability

      - Fear or missing potentially lethal cancels

      - Patient’s expectations about mammograms

   (2) Concerns with and leading to overuse of screening