Schroy Paul C, Caron Sarah E, Sherman Bonnie J, Heeren Timothy C, Battaglia Tracy A
Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA.
Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
Health Expect. 2015 Oct;18(5):1327-38. doi: 10.1111/hex.12110. Epub 2013 Jul 30.
Shared decision making (SDM) related to test preference has been advocated as a potentially effective strategy for increasing adherence to colorectal cancer (CRC) screening, yet primary care providers (PCPs) are often reluctant to comply with patient preferences if they differ from their own. Risk stratification advanced colorectal neoplasia (ACN) provides a rational strategy for reconciling these differences.
To assess the importance of risk stratification in PCP decision making related to test preference for average-risk patients and receptivity to use of an electronic risk assessment tool for ACN to facilitate SDM.
Mixed methods, including qualitative key informant interviews and a cross-sectional survey.
PCPs at an urban, academic safety-net institution.
Screening preferences, factors influencing patient recommendations and receptivity to use of a risk stratification tool.
Nine PCPs participated in interviews and 57 completed the survey. Despite an overwhelming preference for colonoscopy by 95% of respondents, patient risk (67%) and patient preferences (63%) were more influential in their decision making than patient comorbidities (31%; P < 0.001). Age was the single most influential risk factor (excluding family history), with <20% of respondents choosing factors other than age. Most respondents reported that they would be likely to use a risk stratification tool in their practice either 'often' (43%) or sometimes (53%).
Risk stratification was perceived to be important in clinical decision making, yet few providers considered risk factors other than age for average-risk patients. Providers were receptive to the use of a risk assessment tool for ACN when recommending an appropriate screening test for select patients.
与检查偏好相关的共同决策（SDM）被倡导为提高结直肠癌（CRC）筛查依从性的一种潜在有效策略，但如果患者偏好与初级保健提供者（PCP）自身的偏好不同，他们往往不愿意遵从。对晚期结直肠肿瘤（ACN）进行风险分层提供了一种协调这些差异的合理策略。
评估风险分层在初级保健提供者针对平均风险患者的检查偏好决策中的重要性，以及对使用ACN电子风险评估工具以促进共同决策的接受程度。
混合方法，包括定性关键信息访谈和横断面调查。
一家城市学术安全网机构的初级保健提供者。
筛查偏好、影响患者推荐的因素以及对使用风险分层工具的接受程度。
9名初级保健提供者参与了访谈，57人完成了调查。尽管95%的受访者压倒性地倾向于结肠镜检查，但患者风险（67%）和患者偏好（63%）在他们的决策中比患者合并症（31%；P<0.001）更具影响力。年龄是最具影响力的单一风险因素（不包括家族史），只有不到20%的受访者选择年龄以外的因素。大多数受访者表示，他们在实践中“经常”（43%）或“有时”（53%）可能会使用风险分层工具。
风险分层在临床决策中被认为很重要，但很少有提供者考虑平均风险患者年龄以外的风险因素。在为特定患者推荐合适的筛查测试时，提供者愿意接受使用ACN风险评估工具。
