Bell Robert A, McDermott Haley, Fancher Tonya L, Green Michael J, Day Frank C, Wilkes Michael S
Department of Communication, Department of Public Health Sciences, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA,
J Gen Intern Med. 2015 Mar;30(3):334-41. doi: 10.1007/s11606-014-3113-5. Epub 2014 Dec 2.
Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer.
To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians.
Randomized two-group design.
121 California and Pennsylvania community physicians.
Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer.
Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer.
Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03).
Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.
许多初级保健医生（PCP）缺乏为遗传性乳腺癌提供筛查和咨询的能力。
评估基于网络的交互式遗传学课程与文本课程对初级保健医生的效果。
随机两组设计。
121名加利福尼亚州和宾夕法尼亚州的社区医生。
基于网络的交互式遗传学课程，与学习遗传学综述文章的对照组医生进行对比评估。教育结束后，医生与一名宣称有遗传性乳腺癌风险的标准化患者（SP）进行互动。
就诊讨论记录针对与遗传性乳腺癌相关的69个主题的有无进行编码。
在所有医生中，病史采集、对检测结果影响的讨论以及伦理和法律问题的探讨都不完整。约一半的医生提供了遗传咨询转诊（54.6%），推荐检测的医生较少（43.8%）。干预组医生比对照组医生更有可能探讨遗传咨询的益处（78.3%对60.7%，P = 0.048），在检测前鼓励进行遗传咨询（38.3%对21.3%，P = 0.048），询问前列腺癌家族史（25.0%对6.6%，P = 0.006），并报告阳性结果表明男性亲属患前列腺癌的风险增加（20.0%对1.6%，P = 0.001）。干预组医生比对照组医生询问德系犹太人血统的可能性更小（13.3%对34.4%，P = 0.01），或者在被问到“你会怎么做？时回答会进行检测的可能性更小（33.3%对54.1%，P = 0.03）。
医生很少进行关键的咨询行为，无论他们是完成了基于网络的交互式培训还是阅读了临床综述，情况都是如此。
