Knowledge of and Attitudes Toward Evidence-Based Guidelines for and Against Clinical Preventive Services: Results from a National Survey

• Published in: The Milbank quarterly Vol. 94; no. 1; pp. 51 - 76
• Main Authors: LANTZ, PAULA M., EVANS, W. DOUGLAS, MEAD, HOLLY, ALVAREZ, CARMEN, STEWART, LISA
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2016; Milbank Memorial Fund; John Wiley and Sons Inc
• Subjects: Adolescent; Adult; Adults; African Americans; Attitude to Health; Attitudes; Cancer; Cancer screening; Clinical practice guidelines; clinical preventive services; Communication; Communication strategies; Communications industries; Companies; Consumer Health Information - organization & administration; Consumer Health Information - standards; Consumer research; Consumers; Cost sharing; Coverage; Decision making; Education; Educational Status; Evidence based; evidence-based guidelines; Evidence-based medicine; Evidence-Based Medicine - legislation & jurisprudence; Evidence-Based Medicine - standards; Female; Government agencies; Group decision making; Guidelines; Guidelines as Topic - standards; Health care; Health care costs; Health care expenditures; Health care policy; Health insurance; Health problems; Health Services Misuse - prevention & control; Humans; Information Dissemination - methods; Insurance; Insurance Benefits - economics; Insurance Benefits - legislation & jurisprudence; Insurance, Health - economics; Insurance, Health - legislation & jurisprudence; Internet; Latin American cultural groups; Male; Mammography; Medical research; Medical screening; Middle Aged; Minority & ethnic groups; National guidelines; Original Investigation; Original Investigations; Participation; patient engagement; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act - standards; Patients; Physician-Patient Relations; Physicians; Population studies; Positive thought; Preventive Health Services - legislation & jurisprudence; Preventive Health Services - standards; Preventive medicine; Probability; Professional attitudes; Public health; Public services; Rationing; Recommendations; Regression Analysis; Respondents; Scientific belief; Scientific evidence; Screening tests; Secondary schools; Sociodemographics; Socioeconomic Factors; Statistical analysis; Statistics; survey research; Surveys and Questionnaires; Task forces; Trust; United States; Young Adult; United States; United States > US; evidence-based guidelines; patient engagement; survey research; clinical preventive services
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12181

Context: Both the underuse and overuse of clinical preventive services are a serious public health problem. The goal of our study was to produce population-based national data that could assist in the design of communication strategies to increase knowledge of and positive attitudes toward evidence-based guidelines for clinical preventive services (including the US Preventive Services Task Force, USPSTF) and to reduce uncertainty among patients when guidelines change or are controversial. Methods: In late 2013 we implemented an Internet-based survey of a nationally representative sample of 2,529 adults via KnowledgePanel, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and those with less than a high school education were oversampled. We then conducted descriptive statistics and multivariable logistic regression analysis to identify the prevalence of and sociodemographic characteristics associated with key knowledge and attitudinal variables. Findings: While 36.4% of adults reported knowing that the Affordable Care Act requires insurance companies to cover proven preventive services without cost sharing, only 7.7% had heard of the USPSTF. Approximately 1 in 3 (32.6%) reported trusting that a government task force would make fair guidelines for preventive services, and 38.2% believed that the government uses guidelines to ration health care. Most of the respondents endorsed the notion that research/scientific evidence and expert medical opinion are important for the creation of guidelines and that clinicians should follow guidelines based on evidence. But when presented with patient vignettes in which a physician made a guideline-based recommendation against a cancer-screening test, less than 10% believed that this recommendation alone, without further dialogue and/or the patient's own research, was sufficient to make such a decision. Conclusions: Given these demonstrated low levels of knowledge and mistrust regarding guidelines, coupled with a strong preference for shared decision making, better consumer education and decision supports for evidence-based guidelines for clinical preventive services are greatly needed.