About half of women don’t agree that clinician performance metrics should be based on breast cancer screening attendance, according to research published April 17 in JAMA Health Forum.
And about two-thirds of women oppose financial incentives linked to higher performance ratings for clinicians, wrote a team led by Laura Scherer, PhD, from Anschutz Medical Campus in Aurora, CO.
“If the public objects to clinician performance metrics when they become aware of them, this could be a latent threat to healthcare trust,” the Scherer team wrote.
Clinician performance metrics aim to increase care that aligns with current guidelines. These help patients choose high-quality clinicians. Clinicians receive a higher performance rating if a certain percentage of patients (80% for example) receive such care, which may be tied to financial incentives as well.
There is debate about this performance assessment framework since clinicians who practice in communities with poor healthcare access may face higher difficulty in achieving higher performance scores.
“Scores based on receipt of preventive care may also disincentivize patient-centered discussions,” the researchers wrote.
Scherer and colleagues conducted a survey study to determine whether patients accept metrics based on receiving care -- in this case breast cancer screening.
“This research was spurred by recent qualitative findings that some women strongly object to performance metrics based on mammography screening attendance,” they wrote. “This finding was surprising because women generally have positive feelings about mammography and welcome efforts to increase access.”
Final analysis included survey responses from 1,905 women with an average age of 44 years, with 73.3% being non-Hispanic white or European American. Of the total, 990 (51.9%) had a household income of less than $75,000, while 1,009 (53%) had less than a four-year college degree.
The researchers reported the following findings:
Over half of respondents (n = 967) said that physicians “probably or definitely should not” be scored based on how many of their patients receive recommended cancer screenings. And 20.9% approved of this metric while the rest were unsure.
About two-thirds of respondents (n = 1,265) said physicians’ salaries should not be decided by these scores. Nearly 800 respondents said this would make them less likely to follow their physician’s advice while 961 said it would lead to less trust in their physician.
Most women (n = 1,592) prefer their physicians’ scores being based on having informed discussions rather than receiving screening mammography.
The study authors called for future work to uncover the reasons for these evaluations. They added that nationally representative surveys are needed to determine the views of the broader U.S. population.
“This study had limitations, as it reported secondary outcomes from a survey about mammography screening and included only women aged 39 to 50 years without a history of breast cancer or BRCA1/2 variants,” the authors wrote.
Read the full study here.
