Critical gaps in knowledge and implementation of recommendations by the US Preventive Services Task Force.

ABSTRACT

Introduction: The United States Preventive Services Task Force (USPSTF) has issued 31 recommendations applicable to non-pregnant adults. We hypothesized variability in knowledge and implementation of these recommendations among US family medicine resident physicians. Methods: We performed two electronic surveys a local survey, and then a nationally-representative, multicenter, survey. We evaluated self-reported knowledge and implementation of USPSTF recommendations related to non-pregnant adults. Results: 84 family medicine residents from 40 residency programs across 25 states participated. Knowledge and implementation of recommendations varied widely. Most residents lacked knowledge relating to breast cancer chemoprophylaxis (9.9 % "known in detail" or "mostly know"), BRCA-related genetic counseling (BRCA-GC) referral (30 %), tuberculosis (TB) screening (41 %), and sexually transmitted infection (STI) counseling (45 %). There is virtually no implementation of recommendations for breast cancer chemoprophylaxis (90 % never/rarely implement). Many residents never/rarely implement recommendations for BRCA-GC referral (75 %), TB screening (62 %), and HIV pre-exposure prophylaxis (61 %). This remained true even for residents in their final year of training. Relative to their male counterparts, female physicians more frequently implemented recommendations for BRCA-GC referral (11 % vs 0 % always/often implement, p = 0.019), cervical cancer screening (100 % vs 83 %, p = 0.019), and folic acid supplementation (60 % vs 29 %, p = 0.007). Knowledge and implementation of recommendations were strongly related (ß = 0.75, 95 % CI 0.50-1.00, p < 0.001, Spearman R2 = 0.56). Conclusion: Critical gaps exist in resident knowledge and implementation of USPSTF recommendations. We discuss urgent implications for cancer prevention, public health, and health equity.