Subramanian Sujha, Klosterman Michelle, Amonkar Mayur M, Hunt Timothy L
RTI, International, USA.
Prev Med. 2004 May;38(5):536-50. doi: 10.1016/j.ypmed.2003.12.011.
To review screening rates and factors impacting patient utilization of colorectal cancer screening tests.
We searched Medline, CancerLit, and PsycInfo for articles on colorectal cancer screening adherence. US studies on average-risk individuals were reviewed to identify: (1) utilization/adherence rates, (2) predictors of patient adherence, (3) correlation between long-term adherence and type of test selected, (4) predictors of physician recommendation of screening tests, and (5) patterns in the type of test recommended by physicians.
In 2000, only 34% of the US population obtained screening within recommended time frames (fecal occult blood test annually, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years). Positive attitude toward screening and physician recommendation result in high adherence while fear of finding cancer and the belief that cancer is fatal result in low adherence. Physician specialty impacts the type of test recommended, while perceived lack of patient adherence is not a consistent barrier to recommending screening tests. Matching individuals with their choice of screening test and newer technology, such as virtual colonoscopy, may help increase adherence.
Additional studies are required on differences in adherence between tests, whether patient preferences impact adherence, and how the physician-patient relationship can be fostered to increase adherence.
回顾结直肠癌筛查率以及影响患者进行结直肠癌筛查检测的因素。
我们在医学数据库（Medline）、癌症文献数据库（CancerLit）和心理学文摘数据库（PsycInfo）中搜索有关结直肠癌筛查依从性的文章。对美国针对平均风险个体的研究进行回顾，以确定：（1）利用率/依从率；（2）患者依从性的预测因素；（3）长期依从性与所选检测类型之间的相关性；（4）医生推荐筛查检测的预测因素；（5）医生推荐的检测类型模式。
2000年，只有34%的美国人口在推荐的时间范围内进行了筛查（每年进行粪便潜血检测，每5年进行一次乙状结肠镜检查，或每10年进行一次结肠镜检查）。对筛查持积极态度和医生的推荐会导致高依从性，而对发现癌症的恐惧以及认为癌症是致命的信念会导致低依从性。医生的专业会影响推荐的检测类型，而认为患者缺乏依从性并非推荐筛查检测的一贯障碍。使个体与他们选择的筛查检测及新技术（如虚拟结肠镜检查）相匹配，可能有助于提高依从性。
需要进一步研究不同检测之间依从性的差异、患者偏好是否影响依从性以及如何促进医患关系以提高依从性。
