Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
BMC Fam Pract. 2009 Nov 30;10:75. doi: 10.1186/1471-2296-10-75.
Lack of time and competing demands limit the ability of patients and providers to engage in informed decision-making discussions about prostate cancer screening during primary care visits. We evaluated a patient recall intervention to mitigate these challenges.
Using mail and telephone outreach we invited men age 50-74 years without a PSA test in the prior 12 months to make appointments with their primary care providers in order to discuss the pros and cons of PSA-based prostate cancer screening. We assessed patient responsiveness to the program, provider documentation of screening discussions, orders for PSA laboratories, and provider attitudes.
Out of 80 eligible patients, 37 (46%) scheduled and 28 (35%) completed a recall appointment. A large majority (91%) of patients eligible for PSA screening received an order for this test. Providers documented PSA discussions more often for these patients than for a recent sample of their other patients who received traditional care (47.8% vs. 12.5%, p = 0.009). Twelve of 14 participating providers felt the program improved their ability to impart information about the risks and benefits of screening, but were uncertain whether it influenced their patients' preexisting preferences for screening. Some expressed doubts about the advisability of PSA-specific appointments.
To a limited extent, this pilot recall intervention enhanced opportunities for discussions of prostate cancer screening between patients and their primary care providers. As currently configured, however, this program was not found to be feasible for this purpose. A future version should promote screening discussions in the context of a broader range of health maintenance concerns and include more detailed, low-literacy information to educate patients in advance of clinic visits.
由于时间有限且存在其他竞争需求，患者和医疗服务提供者在初级保健就诊期间进行有关前列腺癌筛查的知情决策讨论的能力受到限制。我们评估了一种患者召回干预措施，以减轻这些挑战。
我们通过邮件和电话外拨，邀请过去 12 个月内未进行 PSA 检测的 50-74 岁男性与他们的初级保健提供者预约，以讨论基于 PSA 的前列腺癌筛查的利弊。我们评估了患者对该计划的响应情况、提供者对筛查讨论的记录情况、PSA 实验室的订单情况以及提供者的态度。
在 80 名符合条件的患者中，有 37 名（46%）预约，28 名（35%）完成了召回预约。绝大多数（91%）符合 PSA 筛查条件的患者接受了此项检测的订单。与接受传统护理的近期其他患者相比，提供者为这些患者记录 PSA 讨论的频率更高（47.8%比 12.5%，p = 0.009）。14 名参与的提供者中有 12 名认为该计划提高了他们传递有关筛查风险和益处的信息的能力，但不确定它是否影响了患者对筛查的预先存在的偏好。一些人对 PSA 特异性预约的适宜性表示怀疑。
在有限的程度上，这种试点召回干预措施增强了患者与其初级保健提供者之间讨论前列腺癌筛查的机会。然而，就目前的配置而言，该计划不适合实现这一目的。未来的版本应在更广泛的健康维护问题的背景下促进筛查讨论，并包括更详细、低识字水平的信息，以便在就诊前对患者进行教育。
