In the US, guidelines that seek to reduce cancer screening among certain patients often fail to impact clinical practice. Physician's social networks-the web of relationships among individuals-have been shown to be an important factor in the diffusion of innovation and may also be critical in settings where guidelines may conflict and where some guidelines may seek to roll-back, or de-implement, clinical practice. The objective of this exploratory R21 grant is to characterize how information from physicians' social networks defined as their colleagues, friends, and family members along with experiences from their own clinical practice may alter perceptions and recommendations regarding breast cancer screening and how this information affects population rates of screening.
In Aim 1, we will conduct a national survey of physicians to characterize the extent to which their breast cancer screening recommendations are influenced by their experiences with medical colleagues, knowledge of friends and family who have been diagnosed with breast cancer, and encounters with their patients.
In Aim 2, we will use the results of the survey to incorporate physicians into our existing agent-based model of patients' breast cancer screening decisions. The resulting model will allow study of interactions between physicians and patients, capturing the resulting feedback loops. Using this model, we will simulate different interventions by altering how social networks influence patient and provider decision making. With network interventions being increasingly deployed and the evidence base for cancer screening continuing to evolve, the proposed project will help prioritize aspects of interventions that may have the greatest likelihood of success in changing clinical practice.

Public Health Relevance

Social networks have the potential to influence perceptions of risks and benefits associated with preventive health behaviors and may be a crucial factor in efforts to promote changes in clinical practice. This project will examine how physicians' social networks influence their recommendations for breast cancer screening (through surveys) and shape population rates of screening (using simulation models).

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21CA194194-02
Application #
9188042
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Breslau, Erica S
Project Start
2015-12-01
Project End
2018-11-30
Budget Start
2016-12-01
Budget End
2018-11-30
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Radhakrishnan, Archana; Nowak, Sarah A; Parker, Andrew M et al. (2018) Linking physician attitudes to their breast cancer screening practices: A survey of US primary care providers and gynecologists. Prev Med 107:90-102
Radhakrishnan, Archana; Parker, Andrew M; Pollack, Craig E (2017) Specialty Societies and Breast Cancer Screening Recommendations-Reply. JAMA Intern Med 177:1872
Radhakrishnan, Archana; Nowak, Sarah A; Parker, Andrew M et al. (2017) Physician Breast Cancer Screening Recommendations Following Guideline Changes: Results of a National Survey. JAMA Intern Med 177:877-878
Lee, Christoph I; Scheel, John R; Lee, Janie M (2017) Specialty Societies and Breast Cancer Screening Recommendations. JAMA Intern Med 177:1871-1872