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开发并测试一种基于诊所的简短肺癌筛查决策辅助工具,适用于初级保健环境。

Developing and testing a brief clinic-based lung cancer screening decision aid for primary care settings.

机构信息

College of Nursing, University of South Carolina, Columbia, SC, USA.

Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA.

出版信息

Health Expect. 2018 Aug;21(4):796-804. doi: 10.1111/hex.12675. Epub 2018 Feb 23.

Abstract

BACKGROUND

Cancer screening-related decisions require patients to evaluate complex medical information in short time frames, often with primary care providers (PCPs) they do not know. PCPs play an essential role in facilitating comprehensive shared decision making (SDM).

OBJECTIVE

To develop and test a decision aid (DA) and SDM strategy for PCPs and high-risk patients.

DESIGN

The DA was tested with 20 dyads. Each dyad consisted of one PCP and one patient eligible for screening. A prospective, one-group, mixed-method study design measured fidelity, patient values, screening intention, acceptability and satisfaction.

RESULTS

Four PCPs and 20 patients were recruited from an urban academic medical centre. Most patients were female (n = 14, 70%), most had completed high school (n = 15, 75%), and their average age was 65 years old. Half were African American. Patients and PCPs rated the DA as helpful, easy to read and use and acceptable in terms of time frame (observed t = 11.6 minutes, SD 2.7). Most patients (n = 16, 80%) indicated their intent to be screened. PCPs recommended screening for most patients (n = 17, 85%).

CONCLUSIONS

Evidence supports the value of lung cancer screening with LDCT for select high-risk patients. Guidelines endorse engaging patients and their PCPs in SDM discussions. Our findings suggest that using a brief, interactive, plain-language, culturally sensitive, theory-based DA and SDM strategy is feasible, acceptable and may be essential to effectively translate and sustain the adoption of LDCT screening recommendations into the clinic setting.

摘要

背景

癌症筛查相关决策要求患者在短时间内评估复杂的医学信息,通常是与他们不熟悉的初级保健提供者(PCP)一起。PCP 在促进全面共享决策(SDM)方面发挥着重要作用。

目的

为 PCP 和高风险患者开发和测试决策辅助工具(DA)和 SDM 策略。

设计

该 DA 与 20 对医患进行了测试。每对医患中包括一名 PCP 和一名符合筛查条件的患者。采用前瞻性、单组、混合方法研究设计,衡量了忠实度、患者价值观、筛查意愿、可接受性和满意度。

结果

从一家城市学术医疗中心招募了 4 名 PCP 和 20 名患者。大多数患者为女性(n=14,70%),大多数完成了高中学业(n=15,75%),平均年龄为 65 岁。其中一半是非洲裔美国人。患者和 PCP 均认为 DA 具有帮助性、易于阅读和使用,且在时间框架方面可接受(观察到的 t 值为 11.6 分钟,SD 为 2.7)。大多数患者(n=16,80%)表示有意接受筛查。大多数 PCP 建议对患者(n=17,85%)进行筛查。

结论

有证据支持对特定高风险患者进行低剂量计算机断层扫描(LDCT)肺癌筛查。指南支持让患者及其 PCP 参与 SDM 讨论。我们的研究结果表明,使用简短、互动、通俗易懂、具有文化敏感性、基于理论的 DA 和 SDM 策略是可行的、可接受的,并且可能对于将 LDCT 筛查建议有效地转化并持续应用于临床环境至关重要。

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