Screening Mammography in Older Women: A Pilot Study of Residents' Decisions

BACKGROUND: Screening mammography is a commonly employed preventive modality. The employment of mammography in older women is not supported by evidence from clinical trials, largely because elderly women were excluded from such trials. Most guidelines do not recommend routine screening in older women. How residents reason in this gray zone has been subject to little empirical study. PURPOSES: This study sought to answer two questions: How variable are residents' decision responses to mammography screening scenarios in older women where there is no clear evidence? What reasons do residents give to justify these decisions? METHODS: Residents were asked to respond to four scenarios and give their screening recommendations and the reasons justifying their decisions. RESULTS: There was considerable variability in resident responses to the four scenarios. Only in one scenario was there near unanimity on the preferred screening decision. Resident perceptions of quality of life, longevity and understanding of the guidelines were cited as justification for their decisions. CONCLUSION: Clinical preceptors should be aware of how the variability of resident perceptions of such factors as quality of life and prognosis may influence decision-making.