Ahmad F, Stewart D E, Cameron J I, Hyman I
University Health Network Women's Health Program, University of Toronto, Toronto, Ontario, Canada.
J Womens Health Gend Based Med. 2001 Mar;10(2):201-8. doi: 10.1089/152460901300039584.
Several studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians' mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients' embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians' gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.
多项研究强调了医生在确定宫颈癌和乳腺癌筛查率方面的作用，一些城市研究报告称女医生的筛查率更高。北美农村妇女的乳腺癌和宫颈癌筛查率仍然较低。本次调查旨在确定加拿大安大略省农村家庭医生在乳腺癌和宫颈癌筛查的做法及对障碍的认知方面是否存在显著的性别差异。191名在农村地区、小镇或小城市执业的家庭医生（回复率53.1%）完成了一份邮寄问卷。医生的平均年龄为44.4岁（标准差9.9），平均执业年限为16.6年（标准差10.3）。超过90%的医生报告称，他们在定期健康检查期间很可能会进行巴氏试验和临床乳腺检查（CBE），并且他们在进行这些检查时信心十足且操作自如。男性（68%）和女性（32%）医生在进行筛查的可能性、信心水平和操作舒适度以及对乳腺癌和宫颈癌筛查指南的了解方面相似。然而，去年女性医生进行巴氏试验和CBE的自我报告筛查率高于男性医生（p<0.01）。男性医生报告称，患者更频繁地要求他们转诊至另一位医生进行巴氏试验和CBE（p<0.001）。此外，男性医生认为患者的尴尬是进行巴氏试验（p<0.05）和CBE（p<0.01）比女性医生更强的障碍。在乳房X线摄影转诊的筛查率或相关障碍方面未观察到性别差异。这些发现表明，医生的性别在诸如巴氏试验和CBE等性别敏感检查中发挥作用。有必要通过针对男性医生和女性自身的健康教育举措，促进性别敏感癌症筛查检查中的医患互动。还应探索由同性医疗服务提供者提供性别敏感癌症筛查检查的可行性。
