ArticleBMC family practice2003
The nexus of evidence, context, and patient preferences in primary care: postal survey of Canadian family physicians.
Article in BMC family practice, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.BMC medical education · 2017Pooled it
- Evidence-based general practice: a scoping review.BMC primary care · 2025Article
- Context factors in clinical decision-making: a scoping review.BMC medical informatics and decision making · 2025Article
- How Primary Care Physicians Integrate Price Information into Clinical Decision-Making.Journal of general internal medicine · 2017Article
- The practice of palliative care from the perspective of patients and carers.BMJ supportive & palliative care · 2014Article
- Pharmacists' attitudes towards an evidence-based approach for over-the-counter medication.International journal of clinical pharmacy · 2012Article
- EBM in primary care: a qualitative multicenter study in Spain.BMC family practice · 2011Article
- 'First, do no harm': factors that influence pharmacists making decisions about over-the-counter medication: a qualitative study in Northern Ireland.Drug safety · 2010Article
- Perceptions, attitudes and knowledge of evidence-based medicine in primary care in Spain: a study protocol.BMC health services research · 2009Article
- Contextual factors in clinical decision making: national survey of Canadian family physicians.Canadian family physician Medecin de famille canadien · 2005Article
- Breast self-examination: resistance to change.Canadian family physician Medecin de famille canadien · 2005Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence-based medicine is gaining prominence in primary care. This study sought to examine the relationships among family physicians' attitudes toward EBM, contextual factors, and clinical decision-making and to investigate the factors that contribute to 'contrary to evidence' clinical decisions.
methodsA postal survey mailed to a random sample of Canadian family physicians, stratified by age, gender, and practice setting. The main outcome measures were respondents' attitudes toward evidence-based medicine and preferred treatment option in four simulated clinical scenarios with wording randomly varied.
resultsCanadian family physicians report positive attitudes toward EBM, believe that EBM improves patient care, and agree that research findings are useful in the day-to-day management of patients. The scenario study showed that physicians were strongly influenced by a patient demanding/requesting either a screening test (adjusted Odds Ratio [OR] 5.15, 95% confidence interval [CI] 2.9 to 9.2 for demand mammogram; adjusted OR 3.11, 95% CI 1.7 to 5.6 for request mammogram) or a diagnostic test (adjusted OR 3.95, 95% CI 2.1 to 7.5 for demand lumbar spine x-ray; adjusted OR 2.08, 95% CI 1.1 to 4.1 for request x-ray). This relationship did not hold for the treatment scenario (prescribing antibiotics for acute bronchitis) where hours of practice (adjusted OR 3.5, 95% CI 1.1 to 11.7 for 50+ hours practice; adjusted OR 1.79, 95% CI 1.0 to 3.2 for 20-49 hours practice) and type of practice (adjusted OR 2.22, 95% CI 1.3 to 3.7 for solo practice) were significant. 80% of respondents reported teaching breast self-examination with female physicians twice as likely as males (adjusted OR 2.11, 95% CI 1.2 to 3.8).
conclusionsCanadian family physicians are favourably disposed to the precepts of evidence-based medicine; however, patient expectations and practice characteristics can influence physicians such that decisions are taken that are broadly contrary to evidence. Recently revised models of EBM emphasizing the importance of patient preferences and the clinical context appear to reflect more accurately the clinical reality of primary care physicians.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.