Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2020 Feb;35(2):449-456. doi: 10.1007/s11606-019-05438-0. Epub 2019 Nov 14.
Women aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion.
We conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a "Provider Alert." Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion.
A total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening.
In clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreView's impact on those who are hesitant or reluctant to undergo screening.
ClinicalTrials.gov: NCT02264782.
50-70 岁的女性应接受乳腺癌、宫颈癌（至 65 岁）和结直肠癌（CRC）筛查；50-70 岁的男性应接受 CRC 筛查，并应讨论前列腺癌筛查（PSA）。PreView 是一种交互式、个性化定制的视频医生加提供者警报干预措施，可针对所有筛查或筛查讨论适用于 50-70 岁平均风险人群的癌症。
我们在 6 个临床地点进行了一项随机对照试验。参与者被随机分配到 PreView 或关于健康生活方式的视频。干预组参与者在预约前完成 PreView，他们的临床医生收到“提供者警报”。主要结局是接受乳房 X 光检查、巴氏试验（HPV 检测或不检测）、CRC 筛查（去年进行 FIT 或 10 年内进行结肠镜检查）和 PSA 筛查讨论。其他结果包括乳房、宫颈和 CRC 筛查讨论。
共有 508 人参与，对照组 257 人，干预组 251 人。基线时筛查率相对较高。与基线筛查率相比，乳房 X 光检查或巴氏涂片筛查无显著增加，CRC 筛查略有增加（18%比 12%）。与对照组相比，干预组报告的 PSA 讨论率更高（58%比 36%：P<0.01）。在乳房 X 光检查、宫颈癌和 CRC 筛查的讨论中也观察到类似的增加。
在基线总体筛查率相对较高的诊所中，PreView 并未显著增加乳腺癌、宫颈癌或 CRC 筛查。PreView 导致 PSA 筛查讨论增加。临床医生与患者之间关于所有癌症筛查的讨论显著增加，这表明 PreView 等干预措施可能在推荐讨论筛查的利弊和/或患者不愿意进行筛查时最有用。未来的研究应调查 PreView 对那些犹豫不决或不愿意进行筛查的人的影响。
ClinicalTrials.gov：NCT02264782。
