Zapka Jane G, Lemon Stephenie C
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Cancer. 2004 Sep 1;101(5 Suppl):1165-87. doi: 10.1002/cncr.20504.
Clinicians and the organizations within which they practice play a major role in enabling patient participation in cancer screening and ensuring quality services. Guided by an ecologic framework, the authors summarize previous literature reviews and exemplary studies of breast, cervical, and colorectal cancer screening intervention studies conducted in health care settings. Lessons learned regarding interventions to maximize the potential of cancer screening are distilled. Four broad lessons learned emphasize that multiple levels of factors-public policy, organizational systems and practice settings, clinicians, and patients-influence cancer screening; that a diverse set of intervention strategies targeted at each of these levels can improve cancer screening rates; that the synergistic effects of multiple strategies often are most effective; and that targeting all components of the screening continuum is important. Recommendations are made for future research and practice, including priorities for intervention research specific to health care settings, the need to take research phases into consideration, the need for studies of health services delivery trends, and methods and measurement issues.
临床医生及其执业所在的组织在促使患者参与癌症筛查及确保优质服务方面发挥着重要作用。在一个生态框架的指导下，作者总结了先前在医疗保健环境中进行的乳腺癌、宫颈癌和结直肠癌筛查干预研究的文献综述及典型研究。提炼出了关于最大化癌症筛查潜力的干预措施的经验教训。总结出的四大经验教训强调，多个层面的因素——公共政策、组织系统和实践环境、临床医生以及患者——都会影响癌症筛查；针对这些层面中的每一个层面的一系列不同的干预策略都可以提高癌症筛查率；多种策略的协同效应往往最为有效；以及针对筛查连续统一体的所有组成部分很重要。针对未来的研究和实践提出了建议，包括针对医疗保健环境的干预研究的优先事项、考虑研究阶段的必要性、对卫生服务提供趋势进行研究的必要性以及方法和测量问题。
