医生们了解肺癌筛查的检测特征吗？
Do doctors understand the test characteristics of lung cancer screening?
作者信息
Schmidt Richard, Breyer Marie, Breyer-Kohansal Robab, Urban Matthias, Funk Georg-Christian
机构信息
Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Sanatoriumstr. 2, 1140, Vienna, Austria.
Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstr. 2, 1140, Vienna, Austria.
出版信息
Wien Klin Wochenschr. 2018 Apr;130(7-8):238-246. doi: 10.1007/s00508-017-1305-9. Epub 2018 Jan 25.
BACKGROUND
Screening for lung cancer with a low-dose computed tomography (CT) scan is estimated to prevent 3 deaths per 1000 individuals at high risk; however, false positive results and radiation exposure are relevant harms and deserve careful consideration. Screening candidates can only make an autonomous decision if doctors correctly inform them of the pros and cons of the method; therefore, this study aimed to evaluate whether doctors understand the test characteristics of lung cancer screening.
METHODS
In a randomized trial 556 doctors (members of the Austrian Respiratory Society) were invited to answer questions regarding lung cancer screening based on online case vignettes. Half of the participants were randomized to the group 'solutions provided' and received the correct solutions in advance. The group 'solutions withheld' had to rely on prior knowledge or estimates. The primary endpoint was the between-group difference in the estimated number of deaths preventable by screening. Secondary endpoints were the between-group differences in the prevalence of lung cancer, prevalence of a positive screening results, sensitivity, specificity, positive predictive value, and false negative rate. Estimations were also compared with current data from the literature.
RESULTS
The response rate was 29% in both groups. The reduction in the number of deaths due to screening was overestimated six-fold (95% confidence interval CI: 4-8) compared with the actual data, and there was no effect of group allocation. Providing the correct solutions to doctors had no systematic effect on their answers.
CONCLUSION
Doctors poorly understand the test characteristics of lung cancer screening. Providing the correct solutions in advance did not improve the answers. Continuing education regarding lung cancer screening and the interpretation of test characteristics may be a simple remedy.
CLINICAL TRIAL REGISTRATION
Clinical trial registered with www.clinicaltrials.gov (NCT02542332).
背景
据估计，低剂量计算机断层扫描（CT）筛查肺癌可使每1000名高危个体中预防3例死亡；然而，假阳性结果和辐射暴露是相关危害，值得仔细考虑。只有医生正确告知筛查候选人该方法的利弊，他们才能做出自主决定；因此，本研究旨在评估医生是否了解肺癌筛查的检测特征。
方法
在一项随机试验中，邀请556名医生（奥地利呼吸学会成员）根据在线病例 vignettes回答有关肺癌筛查的问题。一半参与者被随机分配到“提供解决方案”组，并提前收到正确答案。“不提供解决方案”组则必须依靠先前的知识或估计。主要终点是筛查可预防的估计死亡人数的组间差异。次要终点是肺癌患病率、阳性筛查结果患病率、敏感性、特异性、阳性预测值和假阴性率的组间差异。估计值也与当前文献数据进行了比较。
结果
两组的回复率均为29%。与实际数据相比，筛查导致的死亡人数减少被高估了六倍（95%置信区间CI：4-8），并且分组没有影响。向医生提供正确答案对他们的回答没有系统影响。
结论
医生对肺癌筛查的检测特征了解不足。提前提供正确答案并没有改善回答。关于肺癌筛查和检测特征解释的继续教育可能是一种简单的补救措施。
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