Keller Eric J, Crowley-Matoka Megan, Collins Jeremy D, Chrisman Howard B, Milad Magdy P, Vogelzang Robert L
Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611; Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
J Vasc Interv Radiol. 2017 Mar;28(3):420-428. doi: 10.1016/j.jvir.2016.11.008. Epub 2017 Jan 10.
To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids.
Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years.
Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests.
Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.
为了更好地理解介入放射科医生和妇科医生在治疗有症状子宫肌瘤的方法上为何存在差异。
对26位介入放射科医生和妇科医生进行了访谈，内容涉及他们的专业角色、临床推理以及专业内外的实践差异。根据扎根理论和内容分析，使用NVivo 10软件（QSR International，马萨诸塞州伯灵顿）对访谈记录进行系统分析，以确定关键主题，并比较不同专业和实践环境中的主题。数据还补充了对一家大型学术中心11年间治疗的7659例有症状子宫肌瘤患者的回顾性分析。
在一家大型医疗中心，介入放射科医生治疗有症状子宫肌瘤及血管内支架治疗的占比在11年中保持不变（P > 0.05），而微创妇科肌瘤治疗以及医疗补助/医疗保险报销的介入放射学（IR）程序的百分比则显著增加（r > 0.90，P < 0.001和r = 0.93，P < 0.001）。介入放射科医生和妇科医生都致力于为患者做“正确的事”，但每个群体都有独特的专业价值观，影响着他们对医学证据、治疗结果及其同事的看法。当差异明显且令人担忧时，医生往往会怀疑存在不符合患者最佳利益的 ulterior动机。
介入放射科医生和妇科医生在照顾有症状子宫肌瘤患者方面所起的作用上表现出广泛的观点。为促进真正的合作并实现共同目标，利益相关者应寻求并促进对特定专业价值观和文化的更深入理解。
