Possible Unintended Consequence of an Evidence-Based Clinical Policy Change

HOW IT WORKS

In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on “TRACK Comments: Submit a response.”) You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.

CURRENT SELECTION

DISCUSSION QUESTIONS

• What question is asked by this study and why does it matter?

• How does this study advance beyond previous research and clinical practice on this topic?

• How strong is the study design for answering the question? What alternative study designs might be possible?

• To what degree can the findings be accounted for by:

  1. How patients were selected, excluded, or lost to follow-up?

  2. Temporal changes in screening rates due to factors other than the cervical cancer screening guideline change?

  3. How the main variables were measured?

  4. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  5. Chance?

  6. How the findings were interpreted?

• What are the main study findings?

• How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?

• What contextual factors are important for interpreting the findings?

• How might this study change your practice? Policy? Education? Research?

• What are the implications of the study, and of urine tests and primary care office staffing and roles, for screening for sexually transmitted diseases?

• Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?

• What are the next steps in interpreting or applying the findings?

• What researchable questions remain?