Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Geriatric division, Geriatric Medicine Associates, Westminster, Colorado, USA.
J Am Geriatr Soc. 2021 Feb;69(2):524-529. doi: 10.1111/jgs.17016. Epub 2021 Jan 4.
Many older adults with limited life expectancy still receive cancer screening. One potential contributor is that primary care providers (PCP) are not trained to incorporate life expectancy in cancer screening recommendations. We describe the development and evaluation of a novel curriculum to address this need.
We developed and implemented a web-based learning module within a large Maryland group practice with PCPs for older adults. We assessed attitude, knowledge, self-efficacy, and self-reported behavior outcomes before the module, immediately after completing the module, and 6 months afterwards.
Of 172 PCPs who were invited, 86 (50%) completed the module and of these, 50 (58.1%) completed the 6-months follow up survey. Immediately after the module, there was a significant increase in perceived importance of life expectancy (increase of 0.50 point on 10-point scale, 95% confidence intervals (CI) = 0.27-0.73), confidence in predicting life expectancy (increase of 2.32 points on 10-point scale, 95% CI = 1.95-2.70) and confidence in discussion screening cessation (increase of 1.69 points on 10-point scale, 95% CI = 1.37-2.02). Knowledge in patient-preferred communication strategies improved from 55% correct response to 97% (P < .001). However, most of these improvements dissipated by 6 months and there was no change in self-reported behavior at 6 months compared to baseline (P = .34).
Although the module resulted in significant short-term improvement in attitude, knowledge, and self-efficacy, the changes were not sustained over time. Educational interventions such as this can be coupled with ongoing reinforcing strategies and/or decision support interventions to improve cancer-screening practices in older adults.
许多预期寿命有限的老年患者仍在接受癌症筛查。造成这种情况的一个潜在原因是初级保健医生（PCP）未接受过将预期寿命纳入癌症筛查建议的培训。我们描述了一种新的课程的开发和评估，以满足这一需求。
我们在马里兰州的一家大型实践团体中为老年患者的 PCP 开发并实施了一个基于网络的学习模块。我们在模块之前、完成模块后和 6 个月后评估了态度、知识、自我效能和自我报告的行为结果。
在被邀请的 172 名 PCP 中，有 86 名（50%）完成了该模块，其中 50 名（58.1%）完成了 6 个月的随访调查。在模块完成后，对预期寿命的重要性感知有显著提高（10 分制增加 0.50 分，95%置信区间[CI]为 0.27-0.73），预测预期寿命的信心增加（10 分制增加 2.32 分，95%CI 为 1.95-2.70），以及对讨论筛查停止的信心增加（10 分制增加 1.69 分，95%CI 为 1.37-2.02）。患者偏好的沟通策略的知识从 55%的正确回答提高到 97%（P<0.001）。然而，这些改善中的大多数在 6 个月时消失，并且与基线相比，6 个月时自我报告的行为没有变化（P=0.34）。
尽管该模块导致态度、知识和自我效能的短期显著改善，但这些改善并未持续。像这样的教育干预可以与持续的强化策略和/或决策支持干预相结合，以改善老年患者的癌症筛查实践。
