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Table 3 Extracts of discussion notes and written open comments by participating physicians

From: A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system

Discussion notes on prevention
January 2002: October 2002:
Prevention is:
"individual prevention or population prevention?"
"to inform the patient"
"to educate the patient for health: nutrition, etc."
"cancer prevention consists in regular and systematic exam, more specifically according to particular risks of patients"
"a lot of time !" "the activity of prevention is guided more by a the reasons of consultations or the circumstances than by any structured prevention plan."
Demand of patients:
"there is an harmful role of the medias: sometime, patients are informed before we are"
"patients would accept messages of prevention if we had more time with them"
Guidelines:
"there are too many of them" "we lack time to read them"
"we can agree with them but not use them"
"general practitioners are not involved enough in their development" "guidelines avoid to do bibliography and the ANAES is independent from Health Insurance institutions"
Prevention is:
"Prevention is included in the time of regular consultation, according to its context"
"to use appropriate means to avoid accidents and diseases"
"a specific consultation for prevention would be twice longer than regular consultation"
"
Guidelines:
"ANAES guidelines are more acceptable for us when we have the opportunity to work on them in our continuous medical education group"
"we trust the ANAES guidelines more than experts opinions"
"there are a strong pressure by the media on patients concerning PSA screening"
Written open comments on clinical scenario answer forms
January 2002: October 2002:
"the keyboarding is too long in the family history module"
"EsPeR does not take into account the treatment of risk factors"
"Two myocardial infarctions and one stroke in the family (uncles and aunts) do not constitute a familial risk"
"there is no estimated familial risk despite her mother had breast cancer"
"I will prescribe a mammography, even though EsPeR tells me it is not recommended."
"Don't forget that we care of a patient who does not care about his(her) probability or about the cost of his(her) screening test"
"EsPeR helps to be aware of intensity of risks",
"EsPeR helps to balance risk of cardiovascular diseases and risk of cancer",
"I thought I knew the guidelines... finally: I don't",
"I did not find any answer with EsPeR"
"We cannot refuse a mammography screening to a 43 years aged women, even though screening is recommended at 50 years of age."
"There is a strong incentive from laboratories to use PSA for systematic prostate cancer screening" * (it is not recommended by guideline in EsPeR)
"I am questioned in my idea on the pertinence of screening"
Discussion notes on evaluation synthesis
January 2002: October 2002:
"EsPeR is not ready for use in consultation"
"This tool is not appropriate for daily practice"
"EsPeR is easy to use, but difficult to integrate in one consultation"
"EsPeR allow to learn"
"Criteria used to define risk are too strict. In practice, we use fuzzy criteria"
"We trust our clinical experience to estimate risks" "the statistical truth is not the clinical truth"
"I need to adapt guideline to my personal practice"
"cognitive interest of the individualisation of guidelines brought at the moment of decision"
"I was able to integrate the concepts of risk only when I started working with EsPeR.
"I learned something today...I have practiced prevention for 23 years, only based on my common sense"
"The presentation of mortality data provides an interesting tool to communicate with the patient"
"We need a framework to interpret risks or some labels; we do not know how to relate cardiovascular risk with mortality risk"
"more warnings and more active alerts are needed from the estimations of risks"
"highlight individual messages better in guideline messages"
"we often overestimate familial risks"