There are many difficult barriers that prevent clinicians from changing ineffective breast cancer care practices, according to a mixed-methods design study involving more than 7,300 individuals and their oncologists.

Participants had been treated for early-stage breast cancer diagnosed between 2009 and 2012 within the Kaiser Permanente Southern California system. Investigators calculated the number of tests ordered from 2010 to 2014. They then interviewed oncologists who had been placed into high, medium, or low use groups, and looked at patient satisfaction data. Among the results:

• More than 40,000 tests were ordered.
• Perceived patient anxiety, oncologist anxiety, belief that there was nothing else to offer, concern about satisfaction, patient competition, peer use, and system barriers were linked with high test use.
• Concern about harm, and medical center culture were linked with low test use.
• There was no correlation between satisfaction score and test order frequency.

The authors concluded that multifaceted, multilevel strategies to address patient-, clinician-, and system-related barriers are needed.