PRP088: Exploring barriers and facilitators in family physicians to guideline recommended breast cancer screening in women age 40-49

Michelle Nadler, MD; Noah Ivers, MD, PhD; Sarah Neil-Sztramko, PhD; Laura Desveaux; Eitan Amir; Ann Marie Corrado

Abstract

Context: Canadian breast cancer screening guidelines state that women age 40-49 should be informed of benefits and risks of screening mammogram and assisted in making an individualized decision. Data suggest variability by family physicians in the implementation of this recommendation. There is a lack of research to inform the factors underlying this variability. Objectives: To explore the barriers/facilitators of family physician (FP) behaviours related to breast cancer screening (risk assessment, discussion, referral for screening mammogram) in women age 40-49. Study Design, Setting, & Population: One-on-one semi-structured interviews with a sample of FPs in Ontario, Canada. Stratified purposive sampling was used to recruit FPs with high and low screening rates. Interviews and analyses were guided by the Theoretical Domains Framework, a theory-informed, comprehensive approach for examining underlying determinants of behaviour. Transcripts were coded independently by two members of the research team and codes were grouped into categories and themes. Results: Fourteen participants have been recruited (78% women; 21% sub-urban, 79% urban) with member checking and recruitment ongoing. Barriers to breast cancer risk assessment include knowledge of risk factors, skills to synthesize risk (including use of validated risk-calculators), and availability of simple risk-calculation resources. FPs reported confidence in their capabilities to have discussions with women, but there was variability in application and consistency of this behaviour. Differences in beliefs about consequences of screening mammogram in this age-group was noteworthy: some felt that it was crucial for early detection and treatment, while others felt that it led to too many false positives, additional testing, and patient anxiety. There was low knowledge regarding specific risks of screening mammography. A key barrier identified was ‘guideline clarity’ with most FPs uncertain which specific behaviour(s) were guideline recommended. Conclusions: Barriers to guideline-concordant care for breast cancer screening in women age 40-49 include risk assessment skills and resources, guideline clarity, and variable beliefs about consequences of screening mammography. Further data collection and analysis are underway to explore disconfirming evidence and transferability. This information will inform guideline implementation strategies to improve care for women age 40-49.

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