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A study of thrombophilia testing and counseling practices of family physicians using the script concordance method in
N Schneider-MacRae1, S C Jackson, K A Valentine
1Departments of Medicine, University of Calgary, Calgary, Alberta, Canada. n.schneider12@gmail.com
Insights
Family physicians
Area of Science:
- Medical Diagnostics
- Clinical Practice Guidelines
- Hematology Research
Background:
- Thrombophilia testing identifies individuals at risk for venous thromboembolism (VTE).
- Motivations and clinical utility of thrombophilia testing in primary care are often unclear.
- Understanding physician decision-making is crucial for appropriate VTE risk assessment.
Purpose of the Study:
- To evaluate family physicians' (FPs) motivations for ordering thrombophilia testing.
- To compare FP testing practices against expert recommendations.
- To investigate counseling practices related to thrombophilia testing.
Main Methods:
- Survey of family physicians and medical experts using hypothetical patient scenarios.
- Comparison of FP and expert responses using the script concordance method.
- Analysis of factors influencing FP testing decisions and counseling habits.
Main Results:
- Significant disagreement between FPs and experts on the appropriateness of thrombophilia testing in 3 of 5 scenarios.
- FPs were more inclined to test based on patient demographics (male, obese, pediatric) and specific clinical factors (family history, recent events).
- FPs reported higher rates of post-testing counseling compared to pre-testing counseling.
Conclusions:
- Discrepancies exist between FPs and experts regarding the clinical utility of thrombophilia testing.
- The self-reported lack of pre-test counseling by FPs requires further investigation.
- Optimizing thrombophilia testing strategies necessitates aligning clinical practice with evidence-based guidelines.
Background:
Thrombophilia testing helps to identify populations at risk of venous thromboembolism, but motivations for testing individuals are frequently unclear.
Objectives:
Our goals were to assess the motivations for thrombophilia testing among family physicians (FPs) to determine whether testing was congruent with expert opinion, and to study counseling practices.
Methods:
The FPs and experts completed a survey involving hypothetical thrombophilia patients. Responses between groups were compared using the script concordance method.
Results:
The FPs referred 35.9% of cases. Of the five scenarios, two resulted in disagreement regarding appropriateness of testing (P ≤ .037). The FPs were more likely to test male, obese, or pediatric patients, patients with a family history of myocardial infarction or infertility, and patients with a recent event (P ≤ .043). The FPs were more likely to counsel patients after testing (P ≤ .016).
Conclusion:
Disagreement exists between physician groups about the utility of thrombophilia testing. Self-reported lack of pretest counseling among FPs warrants further study.
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