Aminsharifi Alireza, Schulman Ariel, Anderson John, Fish Laura, Oeffinger Kevin, Shah Kevin, Sze Christina, Tay Kae J, Tsivian Efrat, Polascik Thomas J
Division of Urological Surgery, Durham, NC; Department of Urology Shiraz University of Medical Sciences Shiraz, Iran; Duke Cancer Institute, Duke University, Durham, NC.
Division of Urological Surgery, Durham, NC.
Urol Oncol. 2018 Nov;36(11):502.e1-502.e6. doi: 10.1016/j.urolonc.2018.07.016. Epub 2018 Aug 28.
In response to controversy regarding prostate cancer (CaP) screening recommendations, a consolidated Duke Cancer Institute (DCI) multidisciplinary algorithm for CaP screening was developed and implemented. We conducted an online survey within the year following its implementation to assess primary care provider (PCP) attitudes and adoption as well as to evaluate how this program affects screening rates.
A web-based 18-item survey was programmed and was electronically mailed to practicing PCPs at clinics affiliated with the Duke Primary Care system. The survey assessed provider practices and attitudes regarding CaP screening, factors that influenced their general screening recommendations and the confidence related to communicating with patients about screening. The rate of PSA screening before and after implementation of the algorithm was reported across age and race categories.
In sum, 94 of 106 respondents (88.6%) reported discussing the benefits and harms of screening and let their patients decide (52.8%) or recommended for (31.1%) or against (4.7%) screening. Three-fourths of respondents followed a specific panel recommendation such as the United States Preventative Services Task Force (USPSTF) (48.1%), DCI (20%), or the American Urological Association (AUA) (7.4%) guidelines. After integrating this algorithm into the electronic health record, the rate of prostate screening increased between 11% and 20.4% and 15.6% and 16.4% among different age and race categories, respectively. Overall, 79.2% of PCPs felt very confident regarding their ability to communicate the topic of CaP screening with patients.
The DCI multidisciplinary CaP screening algorithm was well adopted among PCPs shortly after its implementation. The rate of screening increased among all age and race categories thereafter. The majority of PCPs involved in this survey felt confident regarding their CaP screening knowledge and most discuss this topic with patients in a shared decision-making model.
针对前列腺癌（CaP）筛查建议引发的争议，制定并实施了杜克癌症研究所（DCI）综合多学科CaP筛查算法。在实施后的一年内，我们开展了一项在线调查，以评估初级保健提供者（PCP）的态度和采用情况，并评估该计划如何影响筛查率。
编制了一份基于网络的包含18个条目的调查问卷，并通过电子邮件发送给杜克初级保健系统附属诊所的执业PCP。该调查评估了提供者关于CaP筛查的实践和态度、影响其一般筛查建议的因素以及与患者沟通筛查相关问题的信心。报告了算法实施前后不同年龄和种族类别的PSA筛查率。
总体而言，106名受访者中有94名（88.6%）报告讨论了筛查的益处和危害，并让患者自行决定（52.8%），或建议进行筛查（31.1%）或反对筛查（4.7%）。四分之三的受访者遵循特定的专家组建议，如美国预防服务工作组（USPSTF）（48.1%）、DCI（20%）或美国泌尿外科学会（AUA）（7.4%）的指南。将该算法整合到电子健康记录中后，不同年龄和种族类别中的前列腺筛查率分别提高了11%至20.4%和15.6%至16.4%。总体而言，79.2%的PCP对自己与患者沟通CaP筛查话题的能力非常有信心。
DCI多学科CaP筛查算法在实施后不久便被PCP广泛采用。此后，所有年龄和种族类别的筛查率均有所提高。参与本次调查的大多数PCP对自己的CaP筛查知识充满信心，并且大多数以共同决策模式与患者讨论这一话题。
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