基层医疗中的癌症疑似病例、紧急转诊及诊断时间：一项基于人群的全科医生调查，该调查嵌套于一项利用信息技术标记出有结直肠癌症状患者的可行性研究之中。
Cancer suspicion in general practice, urgent referral, and time to diagnosis: a population-based GP survey nested within a feasibility study using information technology to flag-up patients with symptoms of colorectal cancer.
作者信息
Kidney Elaine, Greenfield Sheila, Berkman Lindy, Dowswell George, Hamilton William, Wood Sally, Marshall Tom
机构信息
Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Professor of Medical Sociology, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
出版信息
BJGP Open. 2017 Oct 4;1(3):bjgpopen17X101109. doi: 10.3399/bjgpopen17X101109.
BACKGROUND
Patients with symptoms of possible colorectal cancer are not always referred for investigation.
AIM
To ascertain barriers and facilitators to GP referral of patients meeting the National Institute for Health and Care Excellence (NICE) guidelines for urgent referral for suspected colorectal cancer.
DESIGN & SETTING: Qualitative study in the context of a feasibility study using information technology in GP practices to flag-up patients meeting urgent referral criteria for colorectal cancer.
METHOD
Semi-structured interview with 18 GPs and 12 practice managers, focusing on early detection of colorectal cancer, issues in the use of information technology to identify patients and GP referral of these patients for further investigation were audiotaped, transcribed verbatim, and analysed according to emergent themes.
RESULTS
There were two main themes: wide variation in willingness to refer and uncertainty about whether to refer; and barriers to referral. Three key messages emerged: there was a desire to avoid over-referral, lack of knowledge of guidelines, and the use of individually-derived decision rules for further investigation or referral of symptoms. Some GPs were unaware that iron deficiency anaemia or persistent diarrhoea are urgent referral criteria. Alternatives to urgent referral included undertaking no investigations, trials of iron therapy, use of faecal occult blood tests (FOBt) and non-urgent referral. In minority ethnic groups (South Asians) anaemia was often accepted as normal.Concerns about over-referral were linked to financial pressures and perceived criticism by healthcare commissioners, and a reluctance to scare patients by discussing suspected cancer.
CONCLUSION
GPs' lack of awareness of referral guidelines and concerns about over-referral are barriers to early diagnosis of colorectal cancer.
背景
有疑似结直肠癌症状的患者并非总是被转诊去做进一步检查。
目的
确定符合英国国家卫生与临床优化研究所（NICE）关于疑似结直肠癌紧急转诊指南的患者，在全科医生（GP）转诊方面存在的障碍和促进因素。
设计与背景
在一项可行性研究背景下开展的定性研究，该可行性研究利用信息技术在全科医疗实践中标记出符合结直肠癌紧急转诊标准的患者。
方法
对18名全科医生和12名诊所经理进行半结构式访谈，重点围绕结直肠癌的早期检测、利用信息技术识别患者时存在的问题以及这些患者被全科医生转诊做进一步检查的情况。访谈进行了录音，逐字转录，并根据新出现的主题进行分析。
结果
出现了两个主要主题：转诊意愿差异大以及对是否转诊存在不确定性；以及转诊障碍。出现了三条关键信息：希望避免过度转诊、对指南缺乏了解以及使用个人制定的决策规则来对症状进行进一步检查或转诊。一些全科医生不知道缺铁性贫血或持续腹泻是紧急转诊标准。紧急转诊的替代方式包括不做任何检查、铁剂治疗试验、使用粪便潜血试验（FOBt）以及非紧急转诊。在少数族裔群体（南亚人）中，贫血常常被视为正常现象。对过度转诊的担忧与经济压力、医疗保健专员的批评以及不愿因讨论疑似癌症而吓到患者有关。
结论
全科医生对转诊指南缺乏认识以及对过度转诊的担忧是结直肠癌早期诊断的障碍。
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