• 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, and Sarah Feldman.
• Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
• J Gen Intern Med. 2024 Jul 25.

BackgroundGuidelines 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.ObjectiveAssess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results.DesignA 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.ParticipantsPhysicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts.Main MeasuresCorrect response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines.Key ResultsIn 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.ConclusionsClinician 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.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

3 keywords...

hide…