Improving Compliance With Medical Testing Guidelines

The study hypothesis is that clearer visual presentation of guideline recommendations and educational outreach, or academic detailing, can improve guideline compliance. However, it will investigate other aspects of screening-related decision-making, such as provider and patient beliefs about screening, provider-patient communication and patient's willingness to forgo expected testing. The research question is whether educational interventions can decrease non-compliance with screening guidelines for 5 common cancers.

This study is a cluster randomized trial that compares the immediate post-encounter impressions of 12 physicians and 18 of their patients about the discussion of screening for breast, cervical, colorectal, lung and prostate cancer as well as their beliefs about screening efficacy and patient reports of the screening experience. The interventions are educational materials and academic detailing (educational outreach) for providers. The investigators are particularly interested in contrasting the patient and provider recollections, the differential impact on underuse and overuse compliance and whether patient behaviors are consistent with their stated screening plans.

Providers receive standard written screening recommendations and do not receive academic detailing (educational outreach)

Providers receive standard written screening recommendations and receive academic detailing (educational outreach)

Providers receive color-coded written screening recommendations and do not receive academic detailing (educational outreach)

Providers receive color-coded written screening recommendations and receive academic detailing (educational outreach)

A summary of treatment recommendations for each cancer screening is color-coded to indicate the strength and direction of the recommendation

Educational outreach to address the rationale and data supporting recommendations for and against screening

Inclusion Criteria: Patients: healthy men and women ages 30-89 seeing their primary care provider for routine visit Providers: non-pediatric primary care physicians from Mount Sinai Beth Israel or St. Luke's-Roosevelt associated practices Exclusion Criteria: Patient life expectancy of less than 1 year in primary care provider's judgment Inability to read and understand English Transgender status