Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results.
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
Author Information
Tin H Dang: Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Meghan L Rieu-Werden: Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Sarah C Kobrin: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
Jasmin A Tiro: Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL, USA.
Claudia Werner: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jacquelyn M Lykken: Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jessica Chubak: Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Steven J Atlas: Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Robin T Higashi: Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Simon C Lee: Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA.
Jennifer S Haas: Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Celette Sugg Skinner: Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Michelle I Silver: Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Sarah Feldman: Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. sfeldman@bwh.harvard.edu. ORCID
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.
