Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results: Confidence and Knowledge in Abnormal Cervical Screen Management: Dang et al.

Tin H. Dang, Meghan L. Rieu-Werden, Sarah C. Kobrin, Jasmin A. Tiro, Claudia Werner, Jacquelyn M. Lykken, Jessica Chubak, Steven J. Atlas, Robin T. Higashi, Simon C. Lee, Jennifer S. Haas, Celette Sugg Skinner, Michelle I. Silver, Sarah Feldman

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number100153
Pages (from-to)3217-3224
Number of pages8
JournalJournal of general internal medicine
Volume39
Issue number16
DOIs
StatePublished - Dec 2024

Keywords

  • cancer prevention
  • cancer screening
  • cervical cancer

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