Clinical decision-making and mammography referral

Area of Science:

• Primary Care
• Preventive Medicine
• Geriatric Medicine

Background:

• Mammography referral is influenced by physician, practice, and patient factors.
• The impact of advanced patient age and comorbidity on referral decisions is understudied.

Purpose of the Study:

• To investigate physician referral patterns for mammography in relation to patient age and comorbidity.
• To identify factors influencing primary care physicians' decisions to refer older women for mammography.

Main Methods:

• A survey of 132 community-based primary care physicians in two U.S. cities.
• Physicians completed questionnaires regarding their mammography referral practices.

Main Results:

• Referral rates decreased with patient age: 89% for 50-64, 83% for 65-74, and 57% for 80+.
• Lower referral rates were associated with foreign medical graduates, non-board-certified physicians, and residency-trained physicians for older patients.
• Reasons for non-referral included assuming another physician would refer, cost, comorbidity, acute encounter type, and belief that the patient was too old to benefit.

Conclusions:

• Physician referral patterns for mammography vary significantly by patient age, with a notable drop for those 80 and over.
• The findings support a discussion on whether mammography guidelines should prioritize patient age or functional status.
• There is a need to evaluate and openly discuss the decision-making rules physicians use for mammography referrals.