Critical gaps in knowledge and implementation of recommendations by the US Preventive Services Task Force

The United States Preventive Services Task Force (USPSTF) has issued 31 recommendations applicable to non-pregnant adults. We hypothesized variability in knowledge and implementation of these recommendations among US family medicine resident physicians.

We performed two electronic surveys: a local survey, and then a nationally-representative, multicenter, survey. We evaluated self-reported knowledge and implementation of USPSTF recommendations related to non-pregnant adults.

84 family medicine residents from 40 residency programs across 25 states participated. Knowledge and implementation of recommendations varied widely. Most residents lacked knowledge relating to breast cancer chemoprophylaxis (9.9 % "known in detail" or "mostly know"), BRCA-related genetic counseling (BRCA-GC) referral (30 %), tuberculosis (TB) screening (41 %), and sexually transmitted infection (STI) counseling (45 %). There is virtually no implementation of recommendations for breast cancer chemoprophylaxis (90 % never/rarely implement). Many residents never/rarely implement recommendations for BRCA-GC referral (75 %), TB screening (62 %), and HIV pre-exposure prophylaxis (61 %). This remained true even for residents in their final year of training. Relative to their male counterparts, female physicians more frequently implemented recommendations for BRCA-GC referral (11 % vs 0 % always/often implement, p = 0.019), cervical cancer screening (100 % vs 83 %, p = 0.019), and folic acid supplementation (60 % vs 29 %, p = 0.007). Knowledge and implementation of recommendations were strongly related (β = 0.75, 95 % CI 0.50-1.00, p < 0.001, Spearman R² = 0.56).

Critical gaps exist in resident knowledge and implementation of USPSTF recommendations. We discuss urgent implications for cancer prevention, public health, and health equity.