Abdel-Malek Nada, Chiarelli Anna M, Sloan Margaret, Stewart Donna E, Mai Verna, Howlett Roberta I
Division of Preventive Oncology, Cancer Care Ontario, Canada.
Eur J Cancer Prev. 2008 Feb;17(1):48-53. doi: 10.1097/CEJ.0b013e32809b4cef.
Identifying physician and patient characteristics is important in implementing effective, targeted strategies to improve breast cancer detection rates through increased screening recommendations and uptake. The purpose of this study was to determine whether Ontario physicians recommend breast screening using mammography every 2 years for women aged 50-69 as encouraged by the Ontario Breast Screening Program. This study also aimed to identify physician and patient characteristics that may influence adherence to these recommendations. The study design was a cross-sectional study. Using the Canadian Medical Directory-Ontario database, 3063 questionnaires were mailed to all active general and family practitioners. A response rate of 38% (N = 939) was achieved. Adherence to screening was defined as recommending screening to women aged 50-69 only, every 2 years as outlined by the Ontario Breast Screening Program. Bivariate analyses and unconditional logistic regression were used to assess physician adherence to screening guidelines. Only 38.9% of physicians followed recommended breast screening guidelines. After adjusting for physician sex and age, predictors of screening adherence include physicians working in academic or research centers (odds ratio 8.3, 95% confidence interval 1.7-39.7) and those reporting that over 31% of their patients to be of low-income (odds ratio 1.6, 95% confidence interval 1.1-2.4). Compared with physicians working in a rural/town setting (<10 000 people), those located in a large city (>100 000 people) were less likely to adhere to screening guidelines (odds ratio 0.5, 95% confidence interval 0.3-0.7). A low proportion of Ontario physicians adhere to recommended breast screening guidelines. Future research into effective strategies to increase adherence should take into account practice location, setting and patient characteristics.
识别医生和患者的特征对于实施有效的针对性策略以通过增加筛查建议和接受度来提高乳腺癌检测率至关重要。本研究的目的是确定安大略省的医生是否按照安大略省乳腺癌筛查计划的鼓励，为50至69岁的女性每两年推荐一次乳房钼靶筛查。本研究还旨在识别可能影响对这些建议依从性的医生和患者特征。研究设计为横断面研究。利用《加拿大医学名录 - 安大略省》数据库，向所有在职的普通医生和家庭医生邮寄了3063份问卷。回复率为38%（N = 939）。筛查依从性定义为仅按照安大略省乳腺癌筛查计划的概述，为50至69岁的女性每两年推荐一次筛查。采用双变量分析和无条件逻辑回归来评估医生对筛查指南的依从性。只有38.9%的医生遵循推荐的乳房筛查指南。在对医生的性别和年龄进行调整后，筛查依从性的预测因素包括在学术或研究中心工作的医生（优势比8.3，95%置信区间1.7 - 39.7）以及那些报告其超过31%的患者为低收入患者的医生（优势比1.6，95%置信区间1.1 - 2.4）。与在农村/城镇地区（人口<10000人）工作的医生相比，位于大城市（人口>100000人）的医生遵循筛查指南的可能性较小（优势比0.5，95%置信区间0.3 - 0.7）。安大略省只有一小部分医生遵循推荐的乳房筛查指南。未来关于提高依从性的有效策略的研究应考虑执业地点、环境和患者特征。
