与75岁以上成年人讨论停止癌症筛查的脚本和策略：一项定性研究。
Scripts and Strategies for Discussing Stopping Cancer Screening with Adults > 75 Years: a Qualitative Study.
作者信息
Schonberg Mara A, Jacobson Alicia R, Karamourtopoulos Maria, Aliberti Gianna M, Pinheiro Adlin, Smith Alexander K, Schuttner Linnaea C, Park Elyse R, Hamel Mary Beth
机构信息
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1309 Beacon, Office 219, Brookline, MA, 02446, USA.
Division of Geriatrics, Department of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA.
出版信息
J Gen Intern Med. 2020 Jul;35(7):2076-2083. doi: 10.1007/s11606-020-05735-z. Epub 2020 Mar 3.
BACKGROUND
Despite guidelines recommending not to continue cancer screening for adults > 75 years old, especially those with short life expectancy, primary care providers (PCPs) feel ill-prepared to discuss stopping screening with older adults.
OBJECTIVE
To develop scripts and strategies for PCPs to use to discuss stopping cancer screening with adults > 75.
DESIGN
Qualitative study using semi-structured interview guides to conduct individual interviews with adults > 75 years old and focus groups and/or individual interviews with PCPs.
PARTICIPANTS
Forty-five PCPs and 30 patients > 75 years old participated from six community or academic Boston-area primary care practices.
APPROACH
Participants were asked their thoughts on discussions around stopping cancer screening and to provide feedback on scripts that were iteratively revised for PCPs to use when discussing stopping mammography and colorectal cancer (CRC) screening.
RESULTS
Twenty-one (47%) of the 45 PCPs were community based. Nineteen (63%) of the 30 patients were female, and 13 (43%) were non-Hispanic white. PCPs reported using different approaches to discuss stopping cancer screening depending on the clinical scenario. PCPs noted it was easier to discuss stopping screening when the harms of screening clearly outweighed the benefits for a patient. In these cases, PCPs felt more comfortable being more directive. When the balance between the benefits and harms of screening was less clear, PCPs endorsed shared decision-making but found this approach more challenging because it was difficult to explain why to stop screening. While patients were generally enthusiastic about screening, they also reported not wanting to undergo tests of little value and said they would stop screening if their PCP recommended it. By the end of participant interviews, no further edits were recommended to the scripts.
CONCLUSIONS
To increase PCP comfort and capability to discuss stopping cancer screening with older adults, we developed scripts and strategies that PCPs may use for discussing stopping cancer screening.
背景
尽管指南建议不再对75岁以上的成年人进行癌症筛查，尤其是那些预期寿命较短的人，但初级保健提供者（PCP）认为自己没有做好与老年人讨论停止筛查的准备。
目的
为初级保健提供者制定脚本和策略，以便他们与75岁以上的成年人讨论停止癌症筛查。
设计
采用定性研究，使用半结构化访谈指南对75岁以上的成年人进行个人访谈，并对初级保健提供者进行焦点小组访谈和/或个人访谈。
参与者
来自波士顿地区六个社区或学术性初级保健机构的45名初级保健提供者和30名75岁以上的患者。
方法
询问参与者对围绕停止癌症筛查讨论的看法，并对脚本提供反馈，这些脚本经过反复修订，供初级保健提供者在讨论停止乳房X线筛查和结肠直肠癌（CRC）筛查时使用。
结果
45名初级保健提供者中有21名（47%）来自社区。30名患者中有19名（63%）为女性，13名（43%）为非西班牙裔白人。初级保健提供者报告称，根据临床情况，他们会采用不同的方法来讨论停止癌症筛查。初级保健提供者指出，当筛查的危害明显超过对患者的益处时，讨论停止筛查会更容易。在这些情况下，初级保健提供者更愿意采取更直接的方式。当筛查的利弊平衡不太明确时，初级保健提供者支持共同决策，但发现这种方法更具挑战性，因为很难解释为什么要停止筛查。虽然患者通常对筛查很积极，但他们也表示不想接受价值不大的检查，并表示如果初级保健提供者建议，他们会停止筛查。在参与者访谈结束时，没有建议对脚本进行进一步编辑。
结论
为了提高初级保健提供者与老年人讨论停止癌症筛查的舒适度和能力，我们制定了初级保健提供者可用于讨论停止癌症筛查的脚本和策略。
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