Abstract
Objective
The purpose of this study was to identify decision heuristics utilized by primary care physicians in formulating colorectal cancer screening recommendations.
Design
Qualitative research using in-depth semi-structured interviews.
Participants
We interviewed 66 primary care internists and family physicians evenly drawn from academic and community practices. A majority of physicians were male, and almost all were white, non-Hispanic.
Approach
Three researchers independently reviewed each transcript to determine the physician’s decision criteria and developed decision trees. Final trees were developed by consensus. The constant comparative methodology was used to define the categories.
Results
Physicians were found to use 1 of 4 heuristics (“age 50,” “age 50, if family history, then earlier,” “age 50, if family history, then screen at age 40,” or “age 50, if family history, then adjust relative to reference case”) for the timing recommendation and 5 heuristics [“fecal occult blood test” (FOBT), “colonoscopy,” “if not colonoscopy, then...,” “FOBT and another test,” and “a choice between options”) for the type decision. No connection was found between timing and screening type heuristics.
Conclusions
We found evidence of heuristic use. Further research is needed to determine the potential impact on quality of care.
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Acknowledgment
The National Cancer Institute (R21CA102349) and the Agency for Healthcare Research on Quality (R24HS01184503) supported this work. The project was approved by the University of Kentucky Institutional Review Board (#03-0079-P1B). We acknowledge and thank Dr. Jane Peters and April Morgan for conducting interviews and their roles on the analysis team, Dr. Mark Eckman and Dr. Frederick Michel for recruiting participants, Dr. Michael Doukas for clinical consultation, Dr. J. S. Butler for statistical consultation, and Dr. Brian Stevenson for editorial comments. Last but not least, we thank our interview participants.
Conflict of Interest
The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. None of the authors are employed by sponsors or have any other conflict of interest.
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Wackerbarth, S.B., Tarasenko, Y.N., Curtis, L.A. et al. Using Decision Tree Models to Depict Primary Care Physicians CRC Screening Decision Heuristics. J GEN INTERN MED 22, 1467–1469 (2007). https://doi.org/10.1007/s11606-007-0338-6
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DOI: https://doi.org/10.1007/s11606-007-0338-6