Hornung Robin L, Hansen Lori A, Sharp Lisa K, Poorsattar Solmaz P, Lipsky Martin S
Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
Pediatr Dermatol. 2007 Mar-Apr;24(2):108-12. doi: 10.1111/j.1525-1470.2007.00353.x.
Our objective was to utilize the standardized patient technique in assessing the ability of primary care physicians to identify and counsel primary prevention for patients at high risk for skin cancer. A secondary goal was to test the feasibility of this technique as a measure of actual physician behaviors in the outpatient setting. We used a convenience sample of 15 primary care physicians. The standardized patient was an 18-year-old woman with skin phototype I. She presented to physicians as needing a general physical examination for a summer lifeguard job at a beach. She stated a family history of skin cancer. Physician performances were rated using a standard checklist completed by the standardized patient following each visit. We found that none of the physicians asked questions specifically related to skin phototype or sun exposure habits such as childhood sunburns. Only 13% asked about mole changes. For counseling, 67% of physicians recommended sunscreen use; only 7% discussed sunscreen types or procedures for effective use. Only 13% counseled other skin protective behaviors. No significant differences by physician gender were found in these areas; however, female physicians counseled more global health behaviors than male physicians (p < or = 0.01). Our pilot data suggest that little skin cancer primary prevention counseling is performed for high-risk patients. The standardized patient technique worked well in obtaining outcome data for physicians' preventive practices.
我们的目标是利用标准化患者技术来评估初级保健医生识别高危皮肤癌患者并为其提供一级预防咨询的能力。第二个目标是测试该技术作为衡量门诊环境中医生实际行为的可行性。我们采用了15名初级保健医生的便利样本。标准化患者是一名皮肤光类型为I型的18岁女性。她向医生表示，因要在海滩从事夏季救生员工作而需要进行全面体检。她称有皮肤癌家族史。每次就诊后，由标准化患者填写一份标准清单来对医生的表现进行评分。我们发现，没有一位医生询问与皮肤光类型或晒伤习惯（如儿童期晒伤）等具体相关的问题。只有13%的医生询问了痣的变化情况。在提供咨询方面，67%的医生建议使用防晒霜；只有7%的医生讨论了防晒霜类型或有效使用方法。只有13%的医生就其他皮肤保护行为提供了咨询。在这些方面未发现医生性别存在显著差异；然而，女医生比男医生提供了更多关于整体健康行为的咨询（p≤0.01）。我们的试点数据表明，针对高危患者几乎未开展皮肤癌一级预防咨询。标准化患者技术在获取医生预防实践的结果数据方面效果良好。
