PSA 筛查：基层医疗医师实践模式的决定因素。

PSA screening: determinants of primary-care physician practice patterns.

机构信息

Division of Urology, The Children's Hospital of Philadelphia (work conducted while at the University of California, San Francisco, CA, USA), Philadelphia, PA, USA.

出版信息

Prostate Cancer Prostatic Dis. 2012 Jun;15(2):189-94. doi: 10.1038/pcan.2011.59. Epub 2011 Nov 29.

DOI:10.1038/pcan.2011.59

PMID:22343837

Abstract

BACKGROUND

The effect of practice guidelines and the European Randomised Screening for Prostate Cancer (ERSPC) and Prostate, Lung, Colorectal and Ovarian (PLCO) trials on PSA screening practices of primary-care physicians (PCPs) is unknown.

METHODS

We conducted a national cross-sectional on-line survey of a random sample of 3010 PCPs from July to August 2010. Participants were queried about their knowledge of prostate cancer, PSA screening guidelines, the ERSPC and PLCO trials, and about their PSA screening practices. Factors associated with PSA screening were identified using multivariable linear regression.

RESULTS

A total of 152 (5%) participants opened and 89 completed the on-line survey, yielding a response rate of 58% for those that viewed the invitation. Eighty percent of respondents correctly identified prostate cancer risk factors. In all, 51% and 64% reported that they discuss and order PSA screening for men aged 50-75 years, respectively. Fifty-four percent were most influenced by the US Preventative Services Task Force (USPSTF) guidelines. Also, 21% and 28% of respondents stated that their PSA screening practices were influenced by the ERSPC and PLCO trials, respectively. Medical specialty was the only variable associated with propensity to screen, with family medicine physicians more likely to use PSA screening than internists (β=0.21, P=0.02).

CONCLUSIONS

Half of the physicians surveyed did not routinely discuss PSA screening with eligible patients. The impact of the ERSPC and PLCO trials on PSA screening practices was low among US PCPs. USPSTF recommendations for PSA screening continue to be the strongest influence on PCPs' propensity to use PSA screening.

摘要

背景

实践指南以及欧洲前列腺癌随机筛选研究（ERSPC）和前列腺癌、肺癌、结直肠癌和卵巢癌（PLCO）试验对初级保健医生（PCP）进行 PSA 筛查的影响尚不清楚。

方法

我们于 2010 年 7 月至 8 月期间对随机抽取的 3010 名 PCP 进行了一项全国性的在线横断面调查。调查询问了参与者有关前列腺癌、PSA 筛查指南、ERSPC 和 PLCO 试验以及 PSA 筛查实践的知识。使用多变量线性回归确定与 PSA 筛查相关的因素。

结果

共有 152 名（5%）参与者打开并完成了在线调查，对于查看邀请的人来说，响应率为 58%。80%的受访者正确识别了前列腺癌的危险因素。总体而言，分别有 51%和 64%的受访者报告他们分别为 50-75 岁的男性讨论和进行 PSA 筛查。54%的人最受美国预防服务工作组（USPSTF）指南的影响。此外，分别有 21%和 28%的受访者表示，他们的 PSA 筛查实践受到 ERSPC 和 PLCO 试验的影响。医学专业是唯一与筛查倾向相关的变量，家庭医学医师比内科医师更有可能使用 PSA 筛查（β=0.21，P=0.02）。