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美国初级保健中与影像学检查相关的以患者为中心的结局。

Patient-Centered Outcomes Related to Imaging Testing in US Primary Care.

机构信息

Departments of Family Medicine, University of Washington, Seattle, Washington.

Departments of Family Medicine, University of Washington, Seattle, Washington.

出版信息

J Am Coll Radiol. 2019 Feb;16(2):156-163. doi: 10.1016/j.jacr.2018.08.021. Epub 2018 Oct 25.

Abstract

BACKGROUND

Imaging tests are one of the most sophisticated types of diagnostic tools used in health care, yet there are concerns that imaging is overused. Currently, tests are typically evaluated and implemented based on their accuracy, and there is limited knowledge about the range of patient-centered outcomes (PCOs) that imaging tests may lead to. This study explores patients' experiences and subsequent outcomes of imaging tests most notable to patients.

METHODS

Adult patients from four primary care clinics who had an x-ray, CT, MRI, or ultrasound in the 12 months before recruitment participated in a single semistructured interview to recount their imaging experience. Interview transcripts were analyzed thematically.

RESULTS

Four themes related to PCOs were identified from 45 interviews. Participants' mean age was 53 years (25-83 years), 30 had undergone a diagnostic imaging test, and 15 underwent imaging for screening or monitoring. Themes included knowledge gained from the imaging test, its contribution to their overall health care journey, physical experiences during the test procedure, and impacts of the testing process on emotions.

CONCLUSIONS

Patients identified various imaging test outcomes that were important to them. Measurement and reporting these outcomes should be considered more often in diagnostic research. Tools for providers and patients to discuss and utilize these outcomes may help promote shared decision making around the use and impact of imaging tests.

摘要

背景

影像学检查是医疗保健中最复杂的诊断工具之一,但人们担心影像学检查过度使用。目前,通常根据检查的准确性来评估和实施检查,而对于影像学检查可能导致的一系列以患者为中心的结果(PCOs)知之甚少。本研究探讨了患者对影像学检查的体验以及最受患者关注的后续结果。

方法

在招募前的 12 个月内,来自四个初级保健诊所的成年患者接受了 X 光、CT、MRI 或超声检查,他们参加了一次半结构化的访谈,以回忆他们的影像学检查经历。对访谈记录进行了主题分析。

结果

从 45 次访谈中确定了与 PCOs 相关的四个主题。参与者的平均年龄为 53 岁(25-83 岁),其中 30 人接受了诊断性影像学检查,15 人接受了影像学检查用于筛查或监测。主题包括从影像学检查中获得的知识、对整体医疗保健旅程的贡献、检查过程中的身体体验以及检查过程对情绪的影响。

结论

患者确定了对他们重要的各种影像学检查结果。在诊断研究中应更频繁地考虑测量和报告这些结果。为提供者和患者提供讨论和利用这些结果的工具可能有助于促进围绕影像学检查的使用和影响的共同决策。

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