Thompson B, Philcox S, Devereaux B, Metz A, Croagh D, Windsor J, Davaris A, Gupta S, Barlow J, Rhee J, Tagkalidis P, Zimet A, Sharma A, Manocha R, Neale R E
Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia.
Gastroenterology Department, John Hunter Hosptial, New South Wales, Australia.
Pancreatology. 2021 Dec;21(8):1476-1481. doi: 10.1016/j.pan.2021.08.007. Epub 2021 Aug 18.
BACKGROUND/OBJECTIVES: Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways.
A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting.
The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation.
Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.
背景/目的：胰腺癌的诊断常常被延误，这给患者及其家属带来痛苦，并导致较差的生存率。我们旨在开发一种决策支持工具，以帮助初级保健提供者识别应该接受胰腺癌检查的患者，并推荐初始诊断途径。
采用改良的德尔菲法，包括一系列三次调查，以确定临床专家对于哪些体征、症状和危险因素组合应纳入早期识别胰腺癌工具的意见。一组临床专家在焦点小组会议期间最终确定了该工具的开发。
该工具以三个层次呈现体征、症状和危险因素的个体或组合，指导检查的紧迫性。第一层包括5个临床表现和危险因素集群，表明需要对胰腺进行紧急检查。另外5个集群作为第二层，旨在排除其他病因并缩短胰腺检查时间。第三层包括一系列非特异性体征、症状和危险因素，表明需要将胰腺癌作为潜在诊断加以考虑，但没有具体的检查建议。
在初级保健环境中实施之前，现在需要进行前瞻性验证研究。将其纳入初级保健实践并作为一种教育资源，可能有助于快速诊断，并改善诸如痛苦和生存率等结果。
