Montes U, Seijo L M, Campo A, Alcaide A B, Bastarrika G, Zulueta J J
Pulmonary Medicine, Clinical University, University of Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
Eur Respir J. 2007 Sep;30(3):532-7. doi: 10.1183/09031936.00143206. Epub 2007 Jun 13.
Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.
使用计算机断层扫描（CT）进行肺癌筛查在检测早期疾病方面是有效的。然而，人们对依从性提出了担忧。当前作者对2000年至2003年间参加肺癌筛查项目的641名无症状吸烟者进行了一项回顾性观察研究。将依从性好的受试者与依从性差的受试者在肺功能、性别、年龄、入组动机、吸烟状况、到转诊中心的距离、肺癌家族史、石棉暴露、教育程度、初次CT检查发现的结节的存在情况和类型，以及接受旨在提高依从性的护理干预方面进行了比较。总体而言，对研究方案的早期依从率为65%。多变量分析证实了性别、到转诊中心的距离、非钙化结节的存在以及护理干预作为影响对研究方案依从性的因素的重要性。被鼓励参与研究的患者依从性更高，曾经吸烟者也是如此。在多变量分析中观察到了性别交互作用。护理干预对女性有显著影响，而肺功能异常则提高了男性的依从性。女性和居住在转诊中心附近的受试者对肺癌筛查的依从性特别好。本研究表明需要制定新的策略，尤其是针对男性和风险认知较低的受试者的策略，以提高依从性。
