Wanzel Kyle R, Brown Mitchell H, Anastakis Dimitri J, Regehr Glenn
Division of Plastic Surgery, the Centre for Research in Education, University of Toronto, Ontario, Canada.
Plast Reconstr Surg. 2002 Nov;110(6):1441-50; discussion 1451-4. doi: 10.1097/01.PRS.0000030458.86726.50.
Despite the positive impact that reconstructive breast surgery can have on a woman's quality of life, the percentage of eligible candidates that have this procedure remains surprisingly low. The authors hypothesized that this may be attributable to inadequate knowledge, inadequate information, and/or misinformation available to physicians caring for these patients. A needs assessment of primary care physicians, general surgeons, oncologists, and plastic surgeons was conducted to determine referring physicians' current level of knowledge of reconstructive breast surgery and to discover potential learning needs. This comprised a survey, focus groups, and individual interviews. Referring physicians rated their own knowledge of reconstructive breast surgery as low. Plastic surgeons rated their referring physicians' knowledge as even lower. Specific learning needs were identified, as large discrepancies between referring physicians' self-reported knowledge of individual breast reconstruction topics and their own opinion of their relevance were revealed. In addition, despite evidence to the contrary, more than one-third of referring physicians indicated a belief that a breast reconstruction delayed the detection of local cancer recurrence and adversely interfered with adjuvant oncologic therapy. This lack of knowledge and misinformation may be negatively affecting patient referrals to plastic surgeons, as more than one-third of referring physicians and 90 percent of plastic surgeons believed that eligible candidates were not being offered referrals because of inadequate referring physician knowledge of this topic. Furthermore, patients older than 49 years were not being referred despite the fact that plastic surgeons would consider these patients as potential surgical candidates. Referring physician gender affected both referral patterns and perceived importance of reconstructive breast surgery. Finally, personal beliefs and past experiences played a role both in physicians' decisions to refer patients and in patients' decisions to have breast reconstructions. These deficiencies in information, knowledge, and learning needs should be addressed by educational interventions during residency training and through continuing education endeavors.
尽管乳房重建手术对女性生活质量能产生积极影响，但接受该手术的符合条件患者比例仍低得出奇。作者推测，这可能归因于负责这些患者的医生所掌握的知识不足、信息不充分和/或错误信息。对初级保健医生、普通外科医生、肿瘤学家和整形外科医生进行了需求评估，以确定转诊医生目前对乳房重建手术的了解程度，并发现潜在的学习需求。这包括一项调查、焦点小组讨论和个人访谈。转诊医生对自己乳房重建手术知识的评价较低。整形外科医生对其转诊医生知识的评价更低。由于揭示了转诊医生自我报告的对各个乳房重建主题的知识与其自身对这些主题相关性的看法之间存在巨大差异，因此确定了具体的学习需求。此外，尽管有相反证据，但超过三分之一的转诊医生表示认为乳房重建会延迟局部癌症复发的检测，并对辅助肿瘤治疗产生不利干扰。这种知识缺乏和错误信息可能对患者转诊至整形外科医生产生负面影响，因为超过三分之一的转诊医生和90%的整形外科医生认为，由于转诊医生对该主题的知识不足，符合条件的患者未得到转诊。此外，尽管整形外科医生会将49岁以上的患者视为潜在手术对象，但这些患者并未得到转诊。转诊医生的性别影响了转诊模式以及对乳房重建手术的感知重要性。最后，个人信念和过去的经历在医生决定转诊患者以及患者决定进行乳房重建方面都起到了作用。住院医师培训期间的教育干预措施以及通过继续教育努力应解决这些信息、知识和学习需求方面的不足。
