Research Center for Excellence in Clinical Preventive Services, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill2Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill.
Research Center for Excellence in Clinical Preventive Services, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
JAMA Intern Med. 2014 Feb 1;174(2):281-5. doi: 10.1001/jamainternmed.2013.12745.
Making rational decisions about screening requires information about its harms, but high-quality evidence is often either not available or not used. One reason may be that we lack a coherent framework, a taxonomy, for conceptualizing and studying these harms.
To create a taxonomy, we categorized harms from several sources: systematic reviews of screening, other published literature, and informal discussions with clinicians and patients. We used this information to develop an initial taxonomy and vetted it with local and national experts, making revisions as needed.
We propose a taxonomy with 4 domains of harm from screening: physical effects, psychological effects, financial strain, and opportunity costs. Harms can occur at any step of the screening cascade. We provide definitions for each harm domain and illustrate the taxonomy using the example of screening for lung cancer.
The taxonomy provides a systematic way to conceptualize harms as experienced by patients. As shown in the lung cancer screening example, the taxonomy also makes clear where (which domains of harms and which parts of the screening cascade) we have useful information and where there are gaps in our knowledge. The taxonomy needs further testing and validation across a broad range of screening programs. We hope that further development of this taxonomy can improve our thinking about the harms of screening, thus informing our research, policy making, and decision making with patients about the wisdom of screening.
要想对筛查做出合理决策，就必须了解其危害，但高质量的证据往往不是没有，就是没有被采用。原因之一可能是我们缺乏一个连贯的框架，即一个分类学，来对这些危害进行概念化和研究。
为了创建一个分类学，我们从几个来源对危害进行了分类：筛查的系统评价、其他已发表的文献以及与临床医生和患者的非正式讨论。我们利用这些信息开发了一个初始分类学，并与当地和全国的专家进行了核实，根据需要进行了修订。
我们提出了一个包含 4 个筛查危害领域的分类学：身体影响、心理影响、经济压力和机会成本。危害可能发生在筛查级联的任何一个步骤。我们为每个危害领域提供了定义，并通过肺癌筛查的例子来说明分类学。
该分类学为从患者角度对危害进行概念化提供了一种系统的方法。如肺癌筛查示例所示，该分类学还明确了我们有哪些有用的信息（哪些危害领域和筛查级联的哪些部分），以及我们的知识存在哪些空白。该分类学需要在广泛的筛查项目中进一步测试和验证。我们希望进一步开发这个分类学可以改进我们对筛查危害的思考，从而为我们的研究、政策制定以及与患者就筛查的明智性进行决策提供信息。
