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Table 4 Degree of acceptance of guideline messages, possible interpretation and solutions

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

Examples of clinical scenarios (and corresponding guideline message) Acceptance of EsPeR advice# Characterization of the problem of acceptance Possible solution
Tobacco smoking (only the last year consumption is taken into account in EsPeR) Intermediate Lack of knowledge (cardiovascular risk returns to baseline after smoking cessation) More explicit reasoning and detailed explanations
Familial cardiovascular risk of a 60-year old man with 2 brothers who had myocardial infarction at more than 70 years of age... (no familial risk according to the definition used in the guideline) Not acceptable Over estimation of familial risk. Knowledge and evidence disagree with common sense and inherited cultural belief More explanation and information on evidence
Absence of familial risk of breast cancer in a woman whose mother had a breast cancer at 60 and had no other family member having had a cancer Intermediate Knowledge and evidence disagree with common sense and inherited cultural belief More explanation and information on evidence
Breast cancer screening in a 43-year old women at average risk (mammography not recommended as systematic screening, genetic screening only if high familial risk) Not acceptable Over-estimation of familial risk. High pressure (anxiety) of patients for screening without knowledge on benefit and risk of screening More accurate information targeted on both the physician and the patient
Colorectal cancer screening by colonoscopy in a 60-year old man whose father is dead from colorectal cancer at 80 (not recommended in average risk patients except in research programs) Not acceptable Over-estimation of familial risk. Over estimation of the benefit/risk of colonoscopy More explanation and information on evidence
Cervical cancer screening in a 55-year old women (pap smear recommended until 70 years of age) Acceptable - -
Prostate cancer mass screening in men aged more than 50 (screening not recommended) Intermediate Poor knowledge of evidence More information on evidence
  1. # Acceptance: "not acceptable"= no concordance with the recommendation of EsPeR and negative comments from physicians; "intermediate" = no concordance but no negative comments or concordance but negative comments; "acceptable" = concordance with the recommendation of EsPeR and positive comments