Harvard Medical School, Harvard University, Cambridge, Massachusetts.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2022 Jul 1;5(7):e2222131. doi: 10.1001/jamanetworkopen.2022.22131.
Although screenings for breast and colorectal cancer are widely recommended, patient screening rates vary greatly and remain below public health targets, and primary care physicians' (PCPs') counseling and referrals play critical roles in patients' use of cancer screenings. Recent adverse events may influence PCPs' decision-making, but it remains unknown whether cancer screening rates of PCPs' patients change after PCPs are exposed to new cancer diagnoses.
To investigate whether PCPs' exposures to patients with new diagnoses of breast or colorectal cancer were associated with changes in screening rates for other patients subsequently visiting the affected PCPs.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used stacked difference-in-differences analyses of all-payer claims data for New Hampshire and Maine in 2009 to 2015. Participants were PCPs caring for patients. Data analysis was performed from June 2020 to May 2022.
New diagnosis of a PCP's patient with breast cancer or colorectal cancer.
Patients' breast and colorectal cancer screening rates within 1 year of a PCP visit.
The sample included 3158 PCPs (1819 male PCPs [57.6%]) caring for 1 920 189 patients (1 073 408 female patients [55.9%]; mean [SD] age, 41.0 [21.9] years) aged 18 to 64 years. During the study period, 898 PCPs had a patient with a new diagnosis of breast cancer and 370 PCPs had a patient with a new diagnosis of colorectal cancer. In the preexposure period, 68 837 female patients (37.3% of those visiting a PCP) underwent breast cancer screening within 1 year of the visit, and 13 137 patients (10.1% of those visiting a PCP) underwent colorectal cancer screening within 1 year of the visit. For both cancer types, after exposure to a new cancer diagnosis, PCPs' cancer screening rates displayed a rapid, sustained increase. Breast cancer screening rates increased by 4.5 percentage points (95% CI, 3.0-6.1 percentage points; P < .001). Colorectal cancer screening rates increased by 1.3 percentage points (95% CI, 0.3-2.2 percentage points; P = .01). Observed breast cancer screening increases were higher for male PCPs than for female PCPs (3.1 percentage points; 95% CI, 0.4-5.8 percentage points; P = .03).
This study found significant, sustained increases in cancer screening rates for patients visiting PCPs recently exposed to new breast and colorectal cancer diagnoses. These findings suggest that PCPs may update practice patterns on the basis of recent patient diagnoses. Future work should assess whether salient cues to PCPs about patient diagnoses when clinically appropriate can improve screening practices.
尽管乳腺癌和结直肠癌的筛查得到广泛推荐，但患者的筛查率差异很大，仍低于公共卫生目标，初级保健医生（PCP）的咨询和转诊在患者使用癌症筛查方面发挥着关键作用。最近的不良事件可能会影响 PCP 的决策，但尚不清楚 PCP 接触到新诊断的乳腺癌或结直肠癌患者后，其患者的癌症筛查率是否会发生变化。
调查 PCP 接触到新诊断的乳腺癌或结直肠癌患者后，其随后就诊的患者的筛查率是否发生变化。
设计、设置和参与者：这项队列研究使用了新罕布什尔州和缅因州 2009 年至 2015 年的所有支付者索赔数据进行分层差分差异分析。参与者是照顾患者的 PCP。数据分析于 2020 年 6 月至 2022 年 5 月进行。
PCP 的患者新诊断为乳腺癌或结直肠癌。
PCP 就诊后 1 年内患者的乳腺癌和结直肠癌筛查率。
样本包括 3158 名 PCP（1819 名男性 PCP[57.6%]）照顾 1920189 名患者（1073408 名女性患者[55.9%]；平均[SD]年龄为 41.0[21.9]岁），年龄在 18 至 64 岁之间。在研究期间，898 名 PCP 有一名患者新诊断为乳腺癌，370 名 PCP 有一名患者新诊断为结直肠癌。在暴露前时期，68837 名女性患者（就诊 PCP 的 37.3%）在就诊后 1 年内接受了乳腺癌筛查，13137 名患者（就诊 PCP 的 10.1%）在就诊后 1 年内接受了结直肠癌筛查。对于这两种癌症类型，在接触到新的癌症诊断后，PCP 的癌症筛查率显示出快速、持续的增加。乳腺癌筛查率增加了 4.5 个百分点（95%CI，3.0-6.1 个百分点；P<0.001）。结直肠癌筛查率增加了 1.3 个百分点（95%CI，0.3-2.2 个百分点；P=0.01）。与女性 PCP 相比，男性 PCP 的乳腺癌筛查率增加幅度更大（3.1 个百分点；95%CI，0.4-5.8 个百分点；P=0.03）。
本研究发现，最近接触到新的乳腺癌和结直肠癌诊断的 PCP 就诊患者的癌症筛查率显著持续增加。这些发现表明，PCP 可能会根据最近的患者诊断更新实践模式。未来的工作应评估临床适当情况下向 PCP 提供有关患者诊断的明显线索是否可以改善筛查实践。
