Sarkadi Anna, Widmark Catarina, Törnberg Sven, Tishelman Carol
Department of Public Health and Caring Sciences, Section for Health Services Research, Uppsala University, SE-751 85 Uppsala, Sweden.
Soc Sci Med. 2004 Mar;58(6):1097-108. doi: 10.1016/s0277-9536(03)00280-6.
Population-based screening has contributed to decreased mortality in cervical cancer. However, the 'hows', 'whos' and 'whens' of screening still concern health professionals and policy makers. As part of a research project aimed at examining a population-based cervical cancer screening program (PCCSP) from different stakeholders' perspectives, the aim of this qualitative interview study was to elucidate the views of gynaecologists, working in both public and private settings, as stakeholders in the PCCSP in the county of Stockholm, Sweden. Results from semi structured interviews with 17 physicians indicate ambiguity in their descriptions of the purpose of both the PCCSP and smear testing in general, leading to different views about appropriate time intervals for Pap-smear testing. The gynaecologists also described experiencing a number of dilemmas related to information content and provision-both prior to screening and in relation to test results. In addition, the gynaecologists tended to differentiate morally through choice of language between women who participate in some form of screening and non-attendees of the PCCSP. There also appeared to be distinctions in how these gynaecologists conceptualised and discussed women receiving Pap-smears, dependent on whether they were regarded as within the category of 'my patients' (seen by the gynaecologist in a private or public setting) or 'the population' (women unknown to the gynaecologist). This study indicates the importance of comprehensively analysing the context of professionals' work when attempting to understand professional attitudes. Seeming disparities in attitudes as well as varying practices may be explained by the simultaneous existence of multiple value systems, applied to different patient populations, as found in this study.
基于人群的筛查有助于降低宫颈癌死亡率。然而，筛查的“方式”“对象”和“时间”仍然是卫生专业人员和政策制定者所关注的问题。作为一项旨在从不同利益相关者角度审视基于人群的宫颈癌筛查项目（PCCSP）的研究项目的一部分，这项定性访谈研究的目的是阐明在瑞典斯德哥尔摩县公共和私立机构工作的妇科医生作为PCCSP利益相关者的观点。对17名医生进行的半结构化访谈结果表明，他们对PCCSP的目的以及一般涂片检查目的的描述存在模糊性，导致对巴氏涂片检查的适当时间间隔有不同看法。妇科医生还描述了在筛查前以及与检测结果相关的信息内容和提供方面遇到的一些困境。此外，妇科医生倾向于通过语言选择在参与某种形式筛查的女性和未参加PCCSP的女性之间进行道德区分。这些妇科医生在概念化和讨论接受巴氏涂片检查的女性时，似乎也存在差异，这取决于她们被视为“我的患者”（妇科医生在私立或公立机构见到的患者）还是“人群”（妇科医生不认识的女性）。这项研究表明，在试图理解专业态度时，全面分析专业人员工作背景的重要性。本研究发现，态度上看似存在的差异以及不同的做法可能是由于同时存在适用于不同患者群体的多种价值体系所致。
