From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond (AHK, CJH, RTS, PL-K), Department of Biostatistics, Virginia Commonwealth University, Richmond (CJH, RTS); OCHIN, Portland, OR (JP), RTI International, Research Triangle Park, NC (EP), Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston (SWV).
J Am Board Fam Med. 2020 Sep-Oct;33(5):779-784. doi: 10.3122/jabfm.2020.05.190378.
Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening.
As part of a randomized controlled trial to test engaging underserved populations in preventive care through online, personalized, educational material, 2417 patients aged 50 to 74 years were randomly selected from the 70,998 patients with an office visit the year prior and mailed a survey to assess decision-making for colorectal cancer screening. Twenty practices in practice-based research networks from 5 diverse states participated. Survey data were supplemented with electronic health record data.
Among respondents, 64% were or became up to date with screening within 3 months of their office visit. The main factor associated with being up to date was the length of the patient-clinician relationship (<6 months vs 5+ years: odds ratio [OR], 0.49; 95% CI, 0.30-0.80). Sharing the decision about screening options with the clinician was a predictor for being up to date compared with patients who made the decision for themselves (OR, 1.75; 95% CI, 1.27-2.44). Only 36% of patients reported being given a choice about screening options. Traditional factors like race, employment, insurance, and education were not associated with screening.
Having a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.
结直肠癌筛查有益。然而，筛查的实施情况仍不尽如人意，服务不足的人群接受适当筛查的风险更大。尽管人们已经了解了许多筛查障碍，但对于决定是否接受结肠镜检查或粪便检测来进行筛查的决策过程，人们的了解还比较有限。
作为一项通过在线、个性化教育材料来吸引服务不足人群参与预防性护理的随机对照试验的一部分，从 70998 名在过去一年中有就诊记录的患者中随机抽取 2417 名年龄在 50 至 74 岁的患者，并向他们邮寄一份调查，以评估他们对结直肠癌筛查的决策情况。来自 5 个不同州的 20 个实践研究网络中的实践参与了该研究。调查数据补充了电子健康记录数据。
在回答调查的受访者中，64%的人在就诊后 3 个月内接受了最新的筛查。与及时进行筛查相关的主要因素是患者与临床医生的关系时间长短（<6 个月比 5 年以上：比值比[OR]，0.49；95%置信区间[CI]，0.30-0.80）。与自己做出筛查决定的患者相比，与临床医生共同做出筛查决定的患者更有可能及时进行筛查（OR，1.75；95%CI，1.27-2.44）。只有 36%的患者报告说可以选择筛查方案。传统因素如种族、就业、保险和教育与筛查无关。
与初级保健临床医生建立长期关系并共同做出决策可能是确保服务不足人群获得循证预防保健的关键因素。
