为什么美国和法国的初级保健医生会为无症状患者开具前列腺特异性抗原检测？
Why do primary care physicians in the United States and France order prostate-specific antigen tests for asymptomatic patients?
作者信息
Sorum Paul Clay, Shim Junseop, Chasseigne Gérard, Bonnin-Scaon Sylvie, Cogneau Joël, Mullet Etienne
机构信息
Department of Medicine, Albany Medical Center, Albany, NY, USA.
出版信息
Med Decis Making. 2003 Jul-Aug;23(4):301-13. doi: 10.1177/0272989X03256010.
PURPOSE
To understand why many primary care physicians in the United States and France order prostate-specific antigen (PSA) tests routinely for their asymptomatic male patients despite "evidence-based" recommendations.
METHODS
Thirty-two U.S. general internists and family practitioners and 33 French generalists judged, for 32 hypothetical male patients seen for routine preventive care, the probability that the patients had asymptomatic prostate cancer and the likelihood that they would order PSA tests. They were also asked about beliefs, attitudes, and knowledge related to prostate cancer.
RESULTS
The significant predictors of ordering more PSA tests in the scenarios were physicians' higher ratings of regret if untested patients were found to have advanced cancer, their greater discomfort if they suspected that patients had illnesses but could not know for sure, and their perceptions of official recommendations as favoring routine testing.
IMPLICATIONS
Nonrational factors can impede physicians' adoption of "evidence-based" recommendations.
目的
了解为何在美国和法国，尽管有“循证”建议，但许多初级保健医生仍会为无症状男性患者常规开具前列腺特异性抗原（PSA）检测。
方法
32名美国普通内科医生和家庭医生以及33名法国全科医生，针对32名前来进行常规预防保健的假设男性患者，判断这些患者患无症状前列腺癌的概率以及他们开具PSA检测的可能性。他们还被问及与前列腺癌相关的信念、态度和知识。
结果
在这些场景中，更多开具PSA检测的显著预测因素是医生如果发现未检测的患者患有晚期癌症会有更高的遗憾评分，他们如果怀疑患者患病但不确定会有更大的不适，以及他们认为官方建议倾向于常规检测。
启示
非理性因素可能会阻碍医生采用“循证”建议。
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