将提醒与医生乳腺癌筛查建议相联系：一项全国性调查的结果
Linking Reminders and Physician Breast Cancer Screening Recommendations: Results From a National Survey.
作者信息
Siembida Elizabeth J, Radhakrishnan Archana, Nowak Sarah A, Parker Andrew M, Pollack Craig Evan
机构信息
Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA.
出版信息
JCO Clin Cancer Inform. 2017 Nov;1:1-10. doi: 10.1200/CCI.17.00090.
PURPOSE
Physician reminders have successfully increased rates of mammography. However, considering recent changes to breast cancer screening guidelines that disagree on the optimal age to start and stop mammography screening, we sought to examine the extent to which reminders have been deployed for breast cancer screening targeting younger and older patients.
METHODS
A mailed survey was sent to a national sample of 2,000 primary care physicians between May and September 2016. Physicians were asked whether they received reminders to screen women in various age groups (40 to 44, 45 to 49, and ≥ 75 years), the organizational screening guidelines they trusted most, and whether they recommended routine breast cancer screening to average-risk women in the different age groups. Using regression models, we assessed the association between reminders and physician screening recommendations, controlling for physician and practice characteristics, and evaluated whether the association varied by the guidelines they trusted.
RESULTS
A total of 871 physicians responded (adjusted response rate, 52.3%). Overall, 28.9% of physicians reported receiving reminders for patient ages 40 to 44 years, 32.5% for patient ages 45 to 49 years, and 16.5% for patient ages ≥ 75 years. Receiving reminders significantly increased the likelihood of physicians recommending mammography screening. In adjusted analyses, 84% (95% CI, 77% to 90%) of physicians who received reminders recommended screening for women ages ≥ 75 versus 65% (95% CI, 62% to 69%) of those who did not receive reminders. The associations between reminders and screening recommendations remained consistent regardless of which guidelines physicians reported trusting.
CONCLUSION
Reminders were significantly associated with increases in physician screening recommendations for mammography, underscoring the need for careful implementation in scenarios where guidelines are discordant.
目的
医生提醒已成功提高了乳腺钼靶检查率。然而，鉴于近期乳腺癌筛查指南发生了变化，这些指南对于开始和停止乳腺钼靶筛查的最佳年龄存在分歧，我们试图研究针对年轻和老年患者进行乳腺癌筛查的提醒措施的应用程度。
方法
2016年5月至9月间，向全国2000名初级保健医生的样本发送了邮寄调查问卷。询问医生是否收到针对不同年龄组（40至44岁、45至49岁和≥75岁）女性进行筛查的提醒、他们最信任的组织筛查指南，以及他们是否向不同年龄组的平均风险女性推荐常规乳腺癌筛查。使用回归模型，我们评估了提醒与医生筛查建议之间的关联，同时控制医生和执业特征，并评估该关联是否因他们信任的指南而异。
结果
共有871名医生回复（调整后的回复率为52.3%）。总体而言，28.9%的医生报告收到针对40至44岁患者的提醒，32.5%的医生收到针对45至49岁患者的提醒，16.5%的医生收到针对≥75岁患者的提醒。收到提醒显著增加了医生推荐乳腺钼靶筛查的可能性。在调整分析中，收到提醒的医生中有84%（95%CI，77%至90%）推荐对≥75岁的女性进行筛查，而未收到提醒的医生中这一比例为65%（95%CI，62%至69%）。无论医生报告信任哪种指南，提醒与筛查建议之间的关联都保持一致。
结论
提醒与医生对乳腺钼靶筛查建议的增加显著相关，这凸显了在指南不一致的情况下谨慎实施的必要性。
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