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