Ferrante Jeanne M, Ohman-Strickland Pamela, Hahn Karissa A, Hudson Shawna V, Shaw Eric K, Crosson Jesse C, Crabtree Benjamin F
Department of Family Medicine, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1515, Somerset, NJ 08873, USA.
Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):2987-94. doi: 10.1158/1055-9965.EPI-08-0177.
Accurate measurement of cancer-preventive behaviors is important for quality improvement, research studies, and public health surveillance. Findings differ, however, depending on whether patient self-report or medical records are used as the data source. We evaluated concordance between patient self-report and medical records on risk factors, cancer screening, and behavioral counseling among primary care patients. Data from patient surveys and medical records were compared from 742 patients in 25 New Jersey primary care practices participating at baseline in SCOPE (supporting colorectal cancer outcomes through participatory enhancements), an intervention trial to improve colorectal cancer screening in primary care offices. Sensitivity, specificity, and rates of agreement describe concordance between self-report and medical records for risk factors (personal or family history of cancer, smoking), cancer screening (breast, cervical, colorectal, prostate), and counseling (cancer screening recommendations, diet or weight loss, exercise, smoking cessation). Rates of agreement ranged from 41% (smoking cessation counseling) to 96% (personal history of cancer). Cancer screening agreement ranged from 61% (Pap and prostate-specific antigen) to 83% (colorectal endoscopy) with self-report rates greater than medical record rates. Counseling was also reported more frequently by self-report (83% by patient self-report versus 34% by medical record for smoking cessation counseling). Deciding which data source to use will depend on the outcome of interest, whether the data is used for clinical decision making, performance tracking, or population surveillance; the availability of resources; and whether a false positive or a false negative is of more concern.
准确测量癌症预防行为对于质量改进、研究以及公共卫生监测至关重要。然而，根据所使用的数据源是患者自我报告还是医疗记录，结果会有所不同。我们评估了初级保健患者在危险因素、癌症筛查和行为咨询方面患者自我报告与医疗记录之间的一致性。在新泽西州25家初级保健机构的742名患者中，比较了患者调查数据和医疗记录数据，这些患者在基线时参与了SCOPE（通过参与性增强支持结直肠癌结局），这是一项旨在改善初级保健机构中结直肠癌筛查的干预试验。敏感性、特异性和一致率描述了自我报告与医疗记录在危险因素（个人或家族癌症史、吸烟）、癌症筛查（乳腺癌、宫颈癌、结直肠癌、前列腺癌）和咨询（癌症筛查建议、饮食或减肥、运动、戒烟）方面的一致性。一致率范围从41%（戒烟咨询）到96%（个人癌症史）。癌症筛查的一致性范围从61%（巴氏涂片和前列腺特异性抗原）到83%（结直肠内镜检查），自我报告率高于医疗记录率。自我报告的咨询频率也更高（戒烟咨询患者自我报告为83%，医疗记录为34%）。决定使用哪种数据源将取决于感兴趣的结果、数据是用于临床决策、绩效跟踪还是人群监测；资源的可用性；以及更关注假阳性还是假阴性。
