Promoting physician preventive practices: needs assessment for CME in breast cancer detection

Needs assessment for a continuing medical education (CME) intervention directed at increasing breast cancer screening of women 50 years of age and older included a survey of target primary care physicians (n = 370) to explore areas of interest for CME in breast cancer detection and to establish baseline screening practices. The survey was completed at community hospital department meetings or by mail with a response rate of 87% (n = 323). Strategies for enhancing response rate and participation in planning included involvement of local physician organizations, use of a focus group of physicians, and attendance at community hospital department meetings. Survey results indicated that the topics of greatest interest for CME included improving patient compliance, risk factors, and patient education. A total of 48% of physician respondents reported referring all their asymptomatic female patients 50 years of age and older for regular screening mammograms; 63% indicated that they perform breast examinations on all such women regularly. Physician concerns that were reported to influence physical breast examination or referral for mammography are discussed, as well as current use of related office systems (e.g., for recall reminders and/or breast self-examination instruction). The results of a survey of women in the target age group residing in the same community are also reviewed in terms of mammography utilization (e.g., the proportion who had a screening mammogram within the last year was 19%) and specific concerns about mammography. The lack of a doctor's recommendation was the most common reason given (45%) for never having had a mammogram. The uses of the data from both surveys for CME program planning are discussed, including the content and design of the programs, along with organizational aspects and strategies for enhancing attendance.