What improves MD cancer screening recommendations?

e13547 Background: Guidelines provide guidance but patient (PT) medical factors and preferences alter recommendations. We studied PT factors that alter the correct recommendation (CR) and physician (MD) advice in real-time cancer breast, colorectal, cervical, lung and prostate cancer screening discussions in a 2x2 cluster-randomized trial of MD educational supports. Methods: We enrolled an age- (30-49, 50-69, 70-89 years) and sex-stratified sample of 18 patients (PTs) who underwent a physical examination at 2 urban hospitals by each of 12 primary care MDs. We assigned screening guideline formatting (color-coding [CC]) and academic detailing (AD) to MDs randomly. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. We classified recommendations (CR) conservatively. PSA screening recommendations were classified as incorrect only when against screening, for men too old ( > 75 yrs) or too young (African American [AA] < 40 or non-AA < 50). For other men, either was considered correct. MD-reported serious comorbidity or stated PT choice against screening were also valid reasons against. Results: Of the first 174 participants, 92 (53%) were male. Subjects were diverse (63% white) and highly educated (87% attended, 61% graduated college). Using age and race alone, 49% should not be PSA screened, increasing to 65% by adding comorbidity (1%) and PT choice (15%). By these criteria, MDs advised correctly in 91% of encounters. In univariate analysis, CC (p = 0.08) and shared decision making (SDM) but not AD, PT education and age tended to increase CR. Conclusions: In a highly educated, diverse patient population, including comorbidity and PT choice increased CR against screening by 16%. CC and SDM tended to increase CR. Simple supports and SDM may improve MD guideline recommendations. Clinical trial information: NCT02430948.