Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
Obstet Gynecol. 2011 Oct;118(4):854-62. doi: 10.1097/AOG.0b013e31822dabc6.
To identify the factors associated with inclusion of a gynecologic oncologist in managing the care of a woman with suspected ovarian cancer.
A vignette-based survey was mailed to 3,200 physicians aged 64 and younger who were randomly sampled from family physician, general internist, and obstetrician-gynecologist (ob-gyn) lists from the American Medical Association Physician Masterfile. The vignette described a 57-year-old woman with pain, bloating, and a suspicious right adnexal mass with ascites. Using multivariable analysis we evaluated patient, physician, and practice characteristics associated with a self-reported referral or inclusion of a gynecologic oncologist in the patient's care.
The response rate was 61.7%. After exclusions we included 569 ob-gyns, 591 family physicians, and 414 general internists. Gynecologic oncologist referral and consultation was self reported by 39.3% of family physicians and 51.0% of general internists (P=.01). Among ob-gyns, 33.7% indicated they would perform surgery and 66.3% recommended consultation or referral. Factors associated with not referring and consulting included patients having Medicaid insurance (family physicians), providers' weekly average number of patients being more than 91 (family physicians and general internists), male sex (family physicians), a rural practice location (general internists), and solo practice (general internists). Factors associated with primary surgical management for ob-gyns were small and remote rural practice locations and Census division.
When presented with a patient with a suspicious ovarian mass, the majority of primary care physicians do not self-report direct referral to a gynecologic oncologist. This may contribute to the high rates of noncomprehensive surgery for ovarian cancer patients in the United States.
II.
确定与妇科肿瘤医生参与管理疑似卵巢癌患者的护理相关的因素。
对来自美国医学协会医师名录的家庭医生、普通内科医生和妇产科医生名单中随机抽取的 64 岁及以下的 3200 名医生进行了基于病例的调查。该病例描述了一位 57 岁的妇女，她有疼痛、腹胀和可疑的右侧附件肿块伴腹水。我们使用多变量分析评估了与报告的转诊或妇科肿瘤医生参与患者治疗相关的患者、医生和实践特征。
回复率为 61.7%。排除后，我们纳入了 569 名妇产科医生、591 名家庭医生和 414 名普通内科医生。39.3%的家庭医生和 51.0%的普通内科医生报告了妇科肿瘤医生的转诊和咨询（P=.01）。在妇产科医生中，33.7%表示他们将进行手术，66.3%建议咨询或转诊。不转诊和不咨询的相关因素包括患者拥有医疗补助保险（家庭医生）、提供者每周的平均患者人数超过 91 人（家庭医生和普通内科医生）、男性（家庭医生）、农村实践地点（普通内科医生）和单独执业（普通内科医生）。与妇产科医生主要进行手术管理相关的因素是小型和偏远的农村实践地点以及人口普查分区。
当遇到疑似卵巢肿块的患者时，大多数初级保健医生不会自行报告直接转诊给妇科肿瘤医生。这可能导致美国卵巢癌患者接受非全面手术的比例较高。
II 级。
