Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, 23298-0149, USA.
Am J Prev Med. 2011 Nov;41(5):480-6. doi: 10.1016/j.amepre.2011.07.018.
The U.S. Preventive Services Task Force advocates use of a 5A's framework (assess, advise, agree, assist, and arrange) for preventive health recommendations.
To describe 5A content of patient-physician colorectal cancer (CRC) screening discussions and physician-recommended screening modality and to test if these vary by whether patient previously received screening recommendation.
Direct observation of periodic health examinations in 2007-2009 among average-risk primary care patients aged 50-80 years due for screening. Qualitative content analyses conducted 2008-2010 used to code office visit audio-recordings for 5A and other discussion content.
Among study-eligible visits (N=415), 59% contained assistance (i.e., help scheduling colonoscopy or delivery of stool cards), but the assess, advise, and agree steps were rarely comprehensively provided (1%-21%), and only 3% included the last step, arrange follow-up. Almost all physicians endorsed screening via colonoscopy (99%), either alone (69%) or in combination with other tests (30%). Patients nonadherent to a prior physician screening recommendation (31%) were less likely to have the reason(s) for screening discussed (37% vs 65%) or be told the endoscopy clinic would call them for scheduling (19% vs 27%), and more likely to have fecal occult blood testing (FOBT) alone (34% vs 25%) or FOBT and colonoscopy recommended (24% vs 14%), and a screening plan negotiated (21% vs 14%). Significance level is p<0.05 for all contrasts.
Most patients due for CRC screening discuss screening with their physician, but with limited application of the 5A's approach. Opportunities to improve CRC screening decision-making are great, particularly among patients who are nonadherent to a prior recommendation from a physician.
美国预防服务工作组提倡使用 5A's 框架（评估、建议、同意、协助和安排）来制定预防保健建议。
描述患者与医生之间关于结直肠癌（CRC）筛查的 5A 内容，以及医生推荐的筛查方式，并检验这些内容是否因患者之前是否接受过筛查建议而有所不同。
对 2007 年至 2009 年期间，年龄在 50-80 岁之间、需要接受筛查的普通风险初级保健患者的定期健康检查进行直接观察。2008 年至 2010 年期间进行的定性内容分析，用于对门诊就诊的音频记录进行 5A 及其他讨论内容的编码。
在符合研究条件的就诊中（N=415），有 59%的就诊包含协助（即帮助安排结肠镜检查或提供粪便卡片），但评估、建议和同意这三个步骤很少能全面提供（1%-21%），仅有 3%包括最后一步，即安排后续检查。几乎所有医生都支持通过结肠镜检查进行筛查（99%），单独使用（69%）或与其他检查联合使用（30%）。对于未遵循医生之前筛查建议的患者（31%），他们更有可能未讨论筛查的原因（37% vs. 65%），或被告知内镜检查诊所将打电话安排他们进行预约（19% vs. 27%），且更有可能接受单独的粪便潜血检测（FOBT）（34% vs. 25%）或 FOBT 和结肠镜检查（24% vs. 14%），以及协商制定筛查计划（21% vs. 14%）。所有对比的显著性水平均为 p<0.05。
大多数需要进行 CRC 筛查的患者会与医生讨论筛查，但 5A's 方法的应用有限。改善 CRC 筛查决策的机会很大，特别是对于那些不遵守医生之前建议的患者。
