Smith Samuel G, Side Lucy, Meisel Susanne F, Horne Rob, Cuzick Jack, Wardle Jane
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Public Health Genomics. 2016;19(4):239-49. doi: 10.1159/000447552. Epub 2016 Jul 12.
The use of tamoxifen and raloxifene as preventive therapy for women at increased risk of breast cancer was approved by the National Institute for Health and Care Excellence (NICE) in 2013. We undertook a qualitative investigation to investigate the factors affecting the implementation of preventive therapy within the UK.
We recruited general practitioners (GPs) (n = 10) and clinicians working in family history or clinical genetics settings (FHCG clinicians) (n = 15) to participate in semi-structured interviews. Data were coded thematically within the Consolidated Framework for Implementation Research.
FHCG clinicians focussed on the perceived lack of benefit of preventive therapy and difficulties interpreting the NICE guidelines. FHCG clinicians felt poorly informed about preventive therapy, and this discouraged patient discussions on the topic. GPs were unfamiliar with the concept of preventive therapy, and were not aware that they may be asked to prescribe it for high-risk women. GPs were reluctant to initiate therapy because it is not licensed, but were willing to continue a prescription if it had been started in secondary or tertiary care.
Barriers to implementing preventive therapy within routine clinical practice are common and could be addressed by engaging all stakeholders during the development of policy documents.
2013年，英国国家卫生与临床优化研究所（NICE）批准使用他莫昔芬和雷洛昔芬作为乳腺癌高危女性的预防性治疗药物。我们进行了一项定性调查，以探究影响在英国实施预防性治疗的因素。
我们招募了10名全科医生（GP）和15名从事家族病史或临床遗传学工作的临床医生（FHCG临床医生）参与半结构化访谈。在实施研究综合框架内对数据进行主题编码。
FHCG临床医生关注预防性治疗的益处被认为不足以及解读NICE指南存在困难。FHCG临床医生觉得对预防性治疗了解不足，这阻碍了与患者就该话题进行讨论。全科医生对预防性治疗的概念不熟悉，并且没有意识到可能会被要求为高危女性开这种药。全科医生不愿开始治疗，因为它未获许可，但如果是在二级或三级医疗中开始的处方，他们愿意继续开具。
在常规临床实践中实施预防性治疗的障碍很常见，可以通过在政策文件制定过程中让所有利益相关者参与来解决。
