Skip to main content

Advertisement

Springer Nature Link
Log in

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

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The data in this study are from the NCI PROSPR II research consortium. Select survey data are provided in supplementary information. EHR data are available upon request after agreements are completed. Additional details are provided at https://healthcaredelivery.cancer.gov/prospr/datashare.html.

References

  1. Sharma KP, Grosse SD, Maciosek MV, et al. Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening. Prev Chronic Dis. 2020;17:E123. https://doi.org/10.5888/pcd17.200039

    Article  PubMed  PubMed Central  Google Scholar 

  2. Davis M, Feldman S. Making Sense of Cervical Cancer Screening Guidelines and Recommendations. Curr Treat Options Oncol. 2015;16(12):55. https://doi.org/10.1007/s11864-015-0373-1

    Article  PubMed  Google Scholar 

  3. Force UPST. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965-1977. https://doi.org/10.1001/jama.2021.6238

    Article  Google Scholar 

  4. Fontham ETH, Wolf AMD, Church TR, et al. Cervical Cancer Screening for Individuals at Average Risk: 2020 Guideline Update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346. https://doi.org/10.3322/caac.21628

    Article  PubMed  Google Scholar 

  5. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. https://doi.org/10.1097/lgt.0000000000000525

    Article  PubMed  PubMed Central  Google Scholar 

  6. Teoh DG, Marriott AE, Isaksson Vogel R, et al. Adherence to the 2012 National Cervical Cancer Screening Guidelines: A Pilot Study. Am J Obstet Gynecol. 2015;212(1):62.e1-9. https://doi.org/10.1016/j.ajog.2014.06.057

    Article  PubMed  Google Scholar 

  7. Haas JS, Sprague BL, Klabunde CN, et al. Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines. J Gen Intern Med. 2016;31(1):52-9. https://doi.org/10.1007/s11606-015-3449-5

    Article  PubMed  Google Scholar 

  8. Min CJ, Massad LS, Dick R, Powell MA, Kuroki LM. Assessing Physician Adherence to Guidelines for Cervical Cancer Screening and Management of Abnormal Screening Results. J Low Genit Tract Dis. 2020;24(4):337-342. https://doi.org/10.1097/lgt.0000000000000558

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vadaparampil ST, Fuzzell LN, Brownstein NC, et al. A Cross-sectional Survey Examining Clinician Characteristics, Practices, and Attitudes Associated with Adoption of the 2019 American Society for Colposcopy and Cervical Pathology Risk-based Management Consensus Guidelines. Cancer. 2023;129(17):2671-2684. https://doi.org/10.1002/cncr.34838

    Article  PubMed  Google Scholar 

  10. MacLaughlin KL, Jacobson RM, St Sauver JL, Jenkins GD, Fan C, Finney Rutten LJ. Awareness and Support of Clinician- and Patient-Collected Human Papillomavirus Testing for Cervical Cancer Screening Among Primary Care Clinicians. Womens Health Rep (New Rochelle). 2022;3(1):10-19. https://doi.org/10.1089/whr.2021.0074

    Article  PubMed  PubMed Central  Google Scholar 

  11. Meyer AN, Payne VL, Meeks DW, Rao R, Singh H. Physicians' Diagnostic Accuracy, Confidence, and Resource Requests: A Vignette Study. JAMA Intern Med. 2013;173(21):1952-8. https://doi.org/10.1001/jamainternmed.2013.10081

    Article  PubMed  Google Scholar 

  12. Cifu AS. Diagnostic Errors and Diagnostic Calibration. JAMA. 2017;318(10):905-906. https://doi.org/10.1001/jama.2017.11030

    Article  PubMed  Google Scholar 

  13. Jaspan O, Wysocka A, Sanchez C, Schweitzer AD. Improving the Relationship Between Confidence and Competence: Implications for Diagnostic Radiology Training From the Psychology and Medical Literature. Acad Radiol. 2022;29(3):428-438. https://doi.org/10.1016/j.acra.2020.12.006

    Article  PubMed  Google Scholar 

  14. Patell R, Karwa A, Lopez R, Burke CA. Trainees' Knowledge and Application of Guideline Recommendations for Colorectal Cancer Screening and Surveillance. Cancer Treat Res Commun. 2019;21:100153. https://doi.org/10.1016/j.ctarc.2019.100153

    Article  PubMed  Google Scholar 

  15. Beaber EF, Kim JJ, Schapira MM, et al. Unifying Screening Processes within the PROSPR Consortium: A Conceptual Model for Breast, Cervical, and Colorectal Cancer Screening. J Natl Cancer Inst. 2015;107(6):djv120. https://doi.org/10.1093/jnci/djv120

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kamineni A, Tiro JA, Beaber EF, et al. Cervical Cancer Screening Research in the PROSPR I Consortium: Rationale, Methods and Baseline Findings from a US cohort. Int J Cancer. 2019;144(6):1460-1473. https://doi.org/10.1002/ijc.31940

    Article  CAS  PubMed  Google Scholar 

  17. Barlow WE, Beaber EF, Geller BM, et al. Evaluating Screening Participation, Follow-up, and Outcomes for Breast, Cervical, and Colorectal Cancer in the PROSPR Consortium. J Natl Cancer Inst. 2020;112(3):238-246. https://doi.org/10.1093/jnci/djz137

    Article  PubMed  Google Scholar 

  18. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. Am J Clin Pathol. 2012;137(4):516-42. https://doi.org/10.1309/ajcptgd94evrsjcg

    Article  PubMed  Google Scholar 

  19. Francis JKR, Rodriguez SA, Dorsey O, et al. Provider Perspectives on Communication and Dismissal Policies with HPV Vaccine Hesitant Parents. Prev Med Rep. 2021;24:101562. https://doi.org/10.1016/j.pmedr.2021.101562

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vora AS, Marroquin M, Rosenthal SL, et al. Residents and Fellows’ Confidence in Prescribing Pre-exposure Prophylaxis (PrEP). Acad Pediatr. 2023;23(6):1282-1287. https://doi.org/10.1016/j.acap.2023.02.017

    Article  PubMed  Google Scholar 

  21. Haas JS, Cheng D, Yu L, et al. Variation in the Receipt of Human Papilloma Virus Co-testing for Cervical Screening: Individual, Provider, Facility and Healthcare System Characteristics. Prev Med. 2022;154:106871. https://doi.org/10.1016/j.ypmed.2021.106871

    Article  PubMed  Google Scholar 

  22. Cuzick J, Myers O, Hunt WC, et al. Human Papillomavirus Testing 2007-2012: Co-testing and Triage Utilization and Impact on Subsequent Clinical Management. Int J Cancer. 2015;136(12):2854-63. https://doi.org/10.1002/ijc.29337

    Article  CAS  PubMed  Google Scholar 

  23. Perkins RB, Adcock R, Benard V, et al. Clinical Follow-up Practices After Cervical Cancer Screening by Co-testing: A Population-based Study of Adherence to U.S. guideline recommendations. Prev Med. 2021;153:106770. https://doi.org/10.1016/j.ypmed.2021.106770

    Article  PubMed  PubMed Central  Google Scholar 

  24. Feldman S, Lykken JM, Haas JS, et al. Factors Associated with Timely Colposcopy Following an Abnormal Cervical Cancer Test Result. Prev Med. 2022;164:107307. https://doi.org/10.1016/j.ypmed.2022.107307

    Article  PubMed  PubMed Central  Google Scholar 

  25. Guido R, Perkins RB. Management of Abnormal Cervical Cancer Screening Test: A Risk-based Approach. Clin Obstet Gynecol. 2023;66(3):478-499. https://doi.org/10.1097/grf.0000000000000794

    Article  PubMed  Google Scholar 

  26. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of Physician Self-assessment Compared with Observed Measures of Competence: A Systematic Review. Jama. 2006;296(9):1094-102. https://doi.org/10.1001/jama.296.9.1094

    Article  CAS  PubMed  Google Scholar 

  27. Eva KW, Regehr G. Self-assessment in the Health Professions: A Reformulation and Research Agenda. Acad Med. 2005;80(10 Suppl):S46-54. https://doi.org/10.1097/00001888-200510001-00015

    Article  PubMed  Google Scholar 

  28. Higashi RT, Kruse G, Richards J, et al. Harmonizing Qualitative Data Across Multiple Health Systems to Identify Quality Improvement Interventions: A Methodological Framework Using PROSPR II Cervical Research Center Data as Exemplar. Int J Qual Methods. 2023;22:16094069231157345. https://doi.org/10.1177/16094069231157345

    Article  Google Scholar 

  29. Atlas SJ, Tosteson ANA, Burdick TE, et al. Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results. JAMA Netw Open. 2022;5(9):e2234194. https://doi.org/10.1001/jamanetworkopen.2022.34194

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kamstra B, Huntington MK. Population Health Management and Cancer Screening. S D Med. Spec 2017;Spec No:37-41.

  31. Coughlin JM, Zang Y, Terranella S, et al. Understanding Barriers to Lung Cancer Screening in Primary Care. J Thorac Dis. 2020;12(5):2536-2544. https://doi.org/10.21037/jtd.2020.03.66

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements:

We thank the following individuals for their contribution to this study: Kimberly A. Harris, MM, Amy J. Wint, MSc, Vivian Lee, BA, and Yuchiao Chang, PhD (all with Massachusetts General Hospital); Aruna Kamineni, PhD, MPH, Alphonse Derus, MS, and Gabrielle Gundersen, MPH (all with Kaiser Permanente Washington); Lisa Quirk, MS, MPH, and Cynthia Ortiz, MPH (University of Texas Southwestern Medical Center); and Noel Santini, MD, MBA, FACP, and Susan Partridge, BSN, MBA, CCRC (Parkland Health).

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (UM1CA221940) and the American Cancer Society (CRP-22-080-01-CTPS).

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Tin H. Dang BA, Meghan L. Rieu-Werden BS, Steven J. Atlas MD, MPH & Jennifer S. Haas MD, MSc

  2. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Sarah C. Kobrin PhD, MPH

  3. Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL, USA

    Jasmin A. Tiro PhD, MPH

  4. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Claudia Werner MD

  5. Parkland Health and Hospital System, Dallas, TX, USA

    Claudia Werner MD

  6. Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jacquelyn M. Lykken PhD, Robin T. Higashi PhD & Celette Sugg Skinner PhD

  7. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jessica Chubak PhD

  8. Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA

    Simon C. Lee PhD

  9. Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Celette Sugg Skinner PhD

  10. Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Michelle I. Silver PhD, ScM

  11. Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Sarah Feldman MD, MPH

Authors
  1. Tin H. Dang BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meghan L. Rieu-Werden BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah C. Kobrin PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jasmin A. Tiro PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Werner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacquelyn M. Lykken PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jessica Chubak PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven J. Atlas MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robin T. Higashi PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Simon C. Lee PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jennifer S. Haas MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Celette Sugg Skinner PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Michelle I. Silver PhD, ScM
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sarah Feldman MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Feldman MD, MPH.

Ethics declarations

Conflict of Interest:

Dang reports travel support from Weill Cornell Medical College. Werner has received travel support from and is a steering committee member of the American Cancer Society National Roundtable on Cervical Cancer (ACS NRTCC). Feldman receives royalties from UpToDate.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior Presentations

North American Primary Care Research Group (NAPCRG) Annual Meeting, November, 2023.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dang, T.H., Rieu-Werden, M.L., Kobrin, S.C. et al. Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08943-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11606-024-08943-z

KEY WORDS

Search

Navigation