Canada Robin E, Turner Barbara
Internal Medicine Residency Program of the Hospital of the University of Pennsylvania, Primary Care Program; Medical Staff, Whiteriver Indian Health Service, Whiteriver, AZ, USA.
J Fam Pract. 2007 Aug;56(8):E1-9.
A physician's recommendation is a powerful motivator for a patient to undergo colonoscopy for colorectal cancer screening, yet little is known about how physicians address this topic.
We recruited 30 primary care physicians and physicians-in-training from 4 practices to counsel a "patient," simulated by a researcher, regarding the need for screening colonoscopy. Audiotapes of the encounters were transcribed. Preserving physician anonymity, we assessed each encounter for key informational points, positive or negative message framing, type of numeracy information, and use of colloquial or technical language.
Most physicians (>/=80%) discussed the benefits of colorectal cancer screening, its status as a standard exploratory procedure, and the use of sedation. However, few (<20%) addressed the risks of colonoscopy, the nuances of scheduling, or the need for dietary and medication changes. Nearly all physicians (98%) used messages that focused on the positive aspects of screening, and many (67%) also used messages that focused on the risk of not screening. Numeracy information generally was expressed simply, but half of physicians used statistical terms. Half used colloquial terms to describe the prep and procedure.
Though most physicians used positive, simple terms to describe colonoscopy, they often omitted key information. Correcting for the areas of insufficient information found in our study--perhaps with supplementary educational sources--will help ensure that patients are adequately prepared for colonoscopy.
医生的建议是促使患者接受结肠镜检查以进行结直肠癌筛查的强大动力，但对于医生如何讨论这一话题却知之甚少。
我们从4家医疗机构招募了30名初级保健医生和实习医生，让他们为一名由研究人员模拟的“患者”提供关于结肠镜筛查必要性的咨询。对咨询过程进行录音并转录。在保证医生匿名的情况下，我们评估每次咨询的关键信息点、正面或负面的信息框架、数字信息的类型以及口语化或专业语言的使用情况。
大多数医生（≥80%）讨论了结直肠癌筛查的益处、其作为标准检查程序的地位以及镇静剂的使用。然而，很少有医生（<20%）提及结肠镜检查的风险、安排的细微差别或饮食和药物调整的必要性。几乎所有医生（98%）使用的信息都侧重于筛查的积极方面，许多医生（67%）还使用了侧重于不进行筛查风险的信息。数字信息通常表述简单，但有一半的医生使用了统计术语。一半的医生使用口语化术语来描述准备工作和检查过程。
尽管大多数医生用积极、简单的术语描述结肠镜检查，但他们往往遗漏关键信息。针对我们研究中发现的信息不足领域进行纠正——或许借助补充教育资源——将有助于确保患者为结肠镜检查做好充分准备。
