Clinical Decision-Making and Mammography Referral

Background.Physician characteristics, practice/structural factors, and patient characteristics have all been found to influence mammography referral. The relationship of a patient's advanced age and comorbidity to the physician's decision has not received much attention. Methods.Community-based, primary care physicians (n= 132) in two medium-sized U.S. cities completed questionnaires. Results.Physicians report that they refer nearly all (89%) of the women ages 50–64 in their practice, slightly fewer of those 65–74 (83%), but many fewer (57%) of those 80 and over. Foreign medical graduates and physicians who are not board certified reported lower referral rates, and those who were residency trained reported substantially lower rates for the oldest patient group. Common reasons for not referring included assuming a gynecologist or another physician will make the referral, patient cost, comorbidity, and type of encounter, i.e., whether the patient is being seen for an acute condition. However, the lowest rate of referral was associated with believing that the patient was too old to benefit from early detection. Conclusions.Results are discussed in terms of the debate about whether guidelines should be based on patient age or functional status and the need to openly discuss and evaluate the decision rules being used.