Jiwa Moyez, Halkett Georgia, Meng Xingqiong, Berg Melissa
Curtin University, GPO Box U1987, Perth, Australia.
BMC Fam Pract. 2014 Sep 13;15:152. doi: 10.1186/1471-2296-15-152.
Patients treated for prostate cancer may present to general practitioners (GPs) for treatment follow up, but may be reticent to have their consultations recorded. Therefore the use of simulated patients allows practitioner consultations to be rated. The aim of this study was to determine whether the speciality of the assessor has an impact on how GP consultation performance is rated.
Six pairs of scenarios were developed for professional actors in two series of consultations by GPs. The scenarios included: chronic radiation proctitis, Prostate Specific Antigen (PSA) 'bounce', recurrence of cancer, urethral stricture, erectile dysfunction and depression or anxiety. Participating GPs were furnished with the patient's past medical history, current medication, prostate cancer details and treatment, details of physical examinations. Consultations were video recorded and assessed for quality by two sets of assessors- a team of two GPs and two Radiation Oncologists deploying the Leicester Assessment Package (LAP). LAP scores by the GPs and Radiation Oncologists were compared.
Eight GPs participated. In Series 1 the range of LAP scores by GP assessors was 61%-80%, and 67%-86% for Radiation Oncologist assessors. The range for GP LAP scores in Series 2 was 51%- 82%, and 56%-89% for Radiation Oncologist assessors. Within GP assessor correlations for LAP scores were 0.31 and 0.87 in Series 1 and 2 respectively. Within Radiation Oncologist assessor correlations were 0.50 and 0.72 in Series 1 and 2 respectively. Radiation Oncologist and GP assessor scores were significantly different for 4 doctors and for some scenarios. Anticipatory care was the only domain where GPs scored participants higher than Radiation Oncologist assessors.
The assessment of GP consultation performance is not consistent across assessors from different disciplines even when they deploy the same assessment tool.
接受前列腺癌治疗的患者可能会前往全科医生（GP）处进行治疗随访，但他们可能不愿让会诊记录下来。因此，使用模拟患者可以对医生的会诊进行评分。本研究的目的是确定评估者的专业是否会对全科医生会诊表现的评分产生影响。
为专业演员设计了六组场景，用于全科医生的两轮会诊。场景包括：慢性放射性直肠炎、前列腺特异性抗原（PSA）“反弹”、癌症复发、尿道狭窄、勃起功能障碍以及抑郁或焦虑。参与的全科医生会收到患者的既往病史、当前用药情况、前列腺癌细节及治疗情况、体格检查细节。会诊过程进行录像，并由两组评估者进行质量评估——一组是两名全科医生，另一组是两名放射肿瘤学家，他们使用莱斯特评估包（LAP）。比较全科医生和放射肿瘤学家的LAP评分。
八名全科医生参与了研究。在第一轮中，全科医生评估者的LAP评分范围为61% - 80%，放射肿瘤学家评估者的评分范围为67% - 86%。在第二轮中，全科医生LAP评分范围为51% - 82%，放射肿瘤学家评估者的评分范围为
