Misra-Hebert Anita D, Hom Grant, Klein Eric A, Bauman Janine M, Gupta Niyati, Ji Xinge, Stephenson Andrew J, Jones J Stephen, Kattan Michael W
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States.
Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, United States.
Front Oncol. 2018 Jun 28;8:238. doi: 10.3389/fonc.2018.00238. eCollection 2018.
As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.
A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients' knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar's and Stuart-Maxwell tests were used to compare pre-and post-survey responses.
14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40-69 at the five clinics with 2-10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% ( = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% ( = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% ( = 0.009).
A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients' knowledge about the screening decision.
由于前列腺癌（PCa）筛查决策通常在门诊初级保健中进行，因此需要一种简短的工具来帮助在繁忙的诊所环境中进行PCa筛查对话。
在五个不同的初级保健诊所对先前创建的一个用于辅助PCa筛查讨论的9项工具进行了测试。招募了15名提供者使用该工具4周，并根据反馈对该工具进行了修订。然后，提供者在常规门诊就诊期间对方便抽样的患者使用该工具。在就诊前和就诊后进行调查，以评估患者对PCa筛查选项的了解以及决策中要考虑的具体因素。使用McNemar检验和Stuart-Maxwell检验来比较调查前后的回答。
15名提供者中有14名完成了反馈调查，并对该工具有积极的反应。然后，所有15名提供者在五个诊所对95名年龄在40-69岁的男性进行了测试，每个诊所测试2-10名患者。从调查前到调查后，强烈同意他们可以选择进行PCa筛查的患者比例从57%增加到72%（P = 0.018），同意个人或家族病史中有可能影响PCa风险的因素的患者比例从34%增加到47%（P = 0.012），同意在决策中应考虑他们对PCa治疗可能的副作用的看法的患者比例从47%增加到61%（P = 0.009）。
在繁忙的初级保健环境中，用于PCa筛查讨论的简短对话工具受到好评，并提高了患者对筛查决策的了解。
