Guerra Carmen E, Jacobs Samantha E, Holmes John H, Shea Judy A
Division of General Internal Medicine, University of Pennsylvania School of Medicine, 1221 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
J Gen Intern Med. 2007 Jul;22(7):901-7. doi: 10.1007/s11606-007-0142-3.
Prostate cancer screening (PCS) is controversial. Ideally, patients should understand the risks and benefits of screening before undergoing PSA testing. This study assessed whether primary care physicians routinely discuss PCS and explored the barriers to and facilitators of these discussions.
Qualitative pilot study involving in-depth, semistructured interviews with 18 purposively sampled, academic and community-based primary care physicians. Barriers and facilitators of PCS discussions were ascertained using both interviews and chart-stimulated recall--a technique utilizing patient charts to probe recall and provide context to physician decision-making during clinic encounters. Analysis was performed using consensus conferences based on grounded theory techniques.
All 18 participating physicians reported that they generally discussed PCS with patients, though 6 reported sometimes ordering PSA tests without discussion. A PCS discussion occurred in only 16 (36%) of the 44 patient-physician encounters when patients were due for PCS that also met criteria for chart-stimulated recall. Barriers to PCS discussion were patient comorbidity, limited education/health literacy, prior refusal of care, physician forgetfulness, acute-care visits, and lack of time. Facilitators of PCS discussion included patient-requested screening, highly educated patients, family history of prostate cancer, African-American race, visits for routine physicals, review of previous PSA results, extra time during encounters, and reminder systems.
PCS discussions sometimes do not occur. Important barriers to discussion are inadequate time for health maintenance, physician forgetfulness, and patient characteristics. Future research should explore using educational and decision support interventions to involve more patients in PCS decisions.
前列腺癌筛查（PCS）存在争议。理想情况下，患者在接受前列腺特异性抗原（PSA）检测前应了解筛查的风险和益处。本研究评估了基层医疗医生是否会常规讨论PCS，并探讨了这些讨论的障碍和促进因素。
定性试点研究，对18名经过目的性抽样的学术型和社区基层医疗医生进行深入的半结构化访谈。通过访谈和病历激发回忆（一种利用患者病历来探究回忆并为临床会诊期间医生决策提供背景信息的技术）来确定PCS讨论的障碍和促进因素。使用基于扎根理论技术的共识会议进行分析。
所有18名参与研究的医生均报告称他们通常会与患者讨论PCS，不过有6名医生报告有时在未进行讨论的情况下就开具PSA检测单。在44次符合病历激发回忆标准且患者应进行PCS的医患会诊中，仅有16次（36%）进行了PCS讨论。PCS讨论的障碍包括患者合并症、教育程度/健康素养有限、先前拒绝治疗、医生遗忘、急诊就诊以及时间不足。PCS讨论的促进因素包括患者要求筛查、高学历患者、前列腺癌家族史、非裔美国人种族、常规体检就诊、复查先前的PSA结果、会诊时有额外时间以及提醒系统。
PCS讨论有时并未进行。讨论的重要障碍是健康维护时间不足、医生遗忘和患者特征。未来的研究应探索使用教育和决策支持干预措施，以使更多患者参与PCS决策。
