探索可能影响初级保健提供者对前列腺癌和结肠癌筛查的讨论及建议的因素。
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
作者信息
Kistler Christine E, Vu Maihan, Sutkowi-Hemstreet Anne, Gizlice Ziya, Harris Russell P, Brewer Noel T, Lewis Carmen L, Dolor Rowena J, Barclay Colleen, Sheridan Stacey L
机构信息
Department of Family Medicine, School of Medicine.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC.
出版信息
Int J Gen Med. 2018 May 17;11:179-190. doi: 10.2147/IJGM.S153887. eCollection 2018.
BACKGROUND
Primary-care providers may contribute to the use of low-value cancer screening.
OBJECTIVE
We sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening.
PATIENTS AND METHODS
This was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers' attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening).
RESULTS
Providers reported they would discuss cancer screening more often than they would recommend it (<0.001). More providers would discuss and recommend screening for CRC than prostate cancer (<0.001), for younger than older patients (<0.001), and when the patient requested it than when not (<0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC).
DISCUSSION
While most providers' reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.
CONCLUSION
More work appears to be needed to help providers to discuss and recommend screening that aligns with value.
背景
初级保健提供者可能会促使人们使用低价值的癌症筛查。
目的
我们试图研究在何种情况下，初级保健提供者会在一系列净效益以及其他已知会影响筛查的因素范围内，讨论并推荐两种癌症筛查服务。
患者与方法
这是一项对美国24家初级保健诊所的126名初级保健提供者进行的横断面调查。参与者完成了针对前列腺癌或结直肠癌（CRC）的两种假设筛查情景的调查。情景中的患者在年龄和筛查请求状态方面有所不同。对于每种情景，提供者表明他们是否会讨论并推荐筛查。提供者还报告了他们的筛查态度以及其他已知会影响筛查的因素（患者就诊时间短、担心诉讼、临床提醒/绩效指标以及筛查指南）的影响。我们研究了提供者的态度与他们对假设的90岁老人（最低价值筛查）的筛查建议之间的关联。
结果
提供者报告称，他们讨论癌症筛查的频率高于推荐筛查的频率（<0.001）。与前列腺癌相比，更多的提供者会讨论并推荐结直肠癌筛查（<0.001）；与老年患者相比，更倾向于年轻患者（<0.001）；患者提出请求时比未提出请求时更多（<0.001）。对于一名90岁的患者，癌症特异性筛查态度每增加一分，筛查建议的可能性就会增加（前列腺癌为30%，结直肠癌为30%）。
讨论
虽然大多数提供者报告的实践模式与净效益一致，但一些提供者会讨论并推荐低价值的癌症筛查，特别是当面对患者请求时。
结论
似乎需要做更多工作来帮助提供者讨论并推荐符合价值的筛查。
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