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

^# 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

Colombet et al. BMC Medical Informatics and Decision Making 2003 3:13   doi:10.1186/1472-6947-3-13