接受低剂量CT扫描的患者中肺癌筛查的不确定性
Lung Cancer Screening Uncertainty among Patients Undergoing LDCT.
作者信息
Hall Daniel L, Lennes Inga T, Carr Alaina, Eusebio Justin R, Yeh Gloria Y, Park Elyse R
机构信息
Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA.
Massachusetts General Hospital Cancer Center, Boston, MAMassachusetts General Hospital Cancer Center, Boston, MA, USA.
出版信息
Am J Health Behav. 2018 Jan 1;42(1):69-76. doi: 10.5993/AJHB.42.1.7.
OBJECTIVES
Lung cancer is the leading cause of cancer death, yet lung screening remains underutilized. Lung cancer screening uncertainty (LCSU), including referral clarity and the perceived accuracy of screening, may hinder utilization and represent an unmet psychosocial need. This study sought to identify correlates of LCSU among lung screening patients.
METHODS
Current and former smokers (N = 169) completed questionnaires assessing LCSU, sociodemographic variables, objective and subjective numeracy, stress, and anxiety, as part of a cross-sectional study of lung screening patients at an academic hospital.
RESULTS
Patients (52% current smok- ers) reported high clarity about the reason for their lung screening referral. Less clarity was as- sociated with lower education, not receiving Medicare, and greater stress and anxiety. Patients perceived lung screening to be moderately accurate, and levels were inversely related to objective numeracy. Subjective numeracy was higher among former versus current smokers (OR = 2.5), yet was unrelated to LCSU variables.
CONCLUSIONS
Several sociodemographic, numeracy, and emotional factors were associated with greater LCSU. With multiple policy and clinical guidelines purporting the uptake of annual lung screening, it is important to identify patients with LCSU and tailor shared decision-making to clarify their uncertainties.
目的
肺癌是癌症死亡的主要原因，但肺癌筛查的利用率仍然较低。肺癌筛查不确定性（LCSU），包括转诊清晰度和对筛查准确性的认知，可能会阻碍其利用率，并代表一种未得到满足的社会心理需求。本研究旨在确定肺癌筛查患者中LCSU的相关因素。
方法
作为对一家学术医院肺癌筛查患者的横断面研究的一部分，现吸烟者和既往吸烟者（N = 169）完成了评估LCSU、社会人口统计学变量、客观和主观数字能力、压力和焦虑的问卷。
结果
患者（52%为现吸烟者）报告称对其肺癌筛查转诊原因的清晰度较高。清晰度较低与较低的教育程度、未参加医疗保险以及更大的压力和焦虑有关。患者认为肺癌筛查的准确性中等，且水平与客观数字能力呈负相关。既往吸烟者的主观数字能力高于现吸烟者（OR = 2.5），但与LCSU变量无关。
结论
几个社会人口统计学、数字能力和情绪因素与更高的LCSU相关。由于多项政策和临床指南都主张进行年度肺癌筛查，识别有LCSU的患者并调整共同决策以澄清他们的不确定性很重要。
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