Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA.
J Womens Health (Larchmt). 2023 Oct;32(10):1104-1110. doi: 10.1089/jwh.2022.0534. Epub 2023 Aug 1.
Provider uncertainty about the appropriate guideline-concordant evaluation of endometrial cancer (EC) symptoms may be a factor in racial inequities in EC. To evaluate the relationship between EC knowledge and reported practice patterns in a nationally representative survey of first-line providers for initial EC symptoms. This was a mailed cross-sectional survey of physicians and nurse practitioners from professional organization roster of providers from Obstetrics and Gynecology (OBGYN), Family Medicine, Internal Medicine, and Emergency Medicine. It queried demographics, practice characteristics, EC knowledge, and guideline-concordant practice patterns via three case vignettes. Regions of low response were retargeted to ensure strong representation among providers caring for Black women patients. EC knowledge was analyzed via a composite score (range: -3 to 10, with higher scores representing more EC knowledge), and adjusted prevalence ratios (PRs) used to test the association between knowledge and reported practice patterns. Among 531 returned surveys (response rate = 38%), OBGYN had highest (53%) frequency of >6 (median) EC knowledge score, and Emergency Medicine had the lowest (15%) ( < 0.001). Nonguideline-concordant practice patterns were reported in 14%, 41%, and 35% of the three EC cases presented. Providers with knowledge >6, ( = 205) were significantly more likely to report guideline-concordant care on case vignettes (PR 1.28-1.36). In a national survey of multi-specialty backgrounds, there were basic knowledge gaps about EC and EC risk factors among providers, and a sizeable proportion reported nonguideline concordant practices. These findings indicate the importance of targeted education and training for first-line providers, as EC incidence rises.
提供者对子宫内膜癌（EC）症状的适当指南一致评估的不确定性可能是 EC 中种族不平等的一个因素。为了评估在针对初始 EC 症状的一线提供者的全国代表性调查中，EC 知识与报告的实践模式之间的关系。这是一项针对妇产科（OBGYN）、家庭医学、内科和急诊医学提供者专业组织名册中的医生和护士从业者的邮寄横断面调查。它通过三个病例描述询问了人口统计学、实践特征、EC 知识和符合指南的实践模式。对低回应地区进行了重新定位，以确保在照顾黑人女性患者的提供者中具有强大的代表性。通过复合评分（范围：-3 至 10，得分越高表示 EC 知识越多）分析 EC 知识，并使用调整后的患病率比（PR）来测试知识与报告的实践模式之间的关联。在 531 份返回的调查中（回应率为 38%），OBGYN 的>6（中位数）EC 知识评分频率最高（53%），而急诊医学的最低（15%）（<0.001）。在提出的三个 EC 病例中，分别有 14%、41%和 35%报告了不符合指南的实践模式。EC 知识>6（=205）的提供者在病例描述中更有可能报告符合指南的护理（PR 1.28-1.36）。在一项针对多专业背景的全国性调查中，提供者对 EC 和 EC 风险因素的基本知识存在差距，而且相当一部分报告了不符合指南的做法。这些发现表明，随着 EC 发病率的上升，针对一线提供者进行有针对性的教育和培训非常重要。
