Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Massachusetts General Hospital, Boston, MA, USA.
Patient Educ Couns. 2024 Feb;119:108047. doi: 10.1016/j.pec.2023.108047. Epub 2023 Nov 10.
Identify if primary care physicians (PCPs) accurately understand patient preferences for colorectal cancer (CRC) testing, whether shared decision making (SDM) training improves understanding of patient preferences, and whether time spent discussing CRC testing improves understanding of patient preferences.
Secondary analysis of a trial comparing SDM training plus a reminder arm to a reminder alone arm. PCPs and their patients completed surveys after visits assessing whether they discussed CRC testing, patient testing preference, and time spent discussing CRC testing. We compared patient and PCP responses, calculating concordance between patient-physician dyads. Multilevel models tested for differences in preference concordance by arm or time discussing CRC.
382 PCP and patient survey dyads were identified. Most dyads agreed on whether CRC testing was discussed (82%). Only 52% of dyads agreed on the patient's preference. SDM training did not impact accuracy of PCPs preference diagnoses (55%v.48%,p = 0.22). PCPs were more likely to accurately diagnose patient's preferences when discussions occurred, regardless of length.
Only half of PCPs accurately identified patient testing preferences. Training did not impact accuracy. Visits where CRC testing was discussed resulted in PCPs better understanding patient preferences.
PCPs should take time to discuss testing and elicit patient preferences.
确定初级保健医生（PCP）是否准确理解患者对结直肠癌（CRC）检测的偏好，共享决策（SDM）培训是否能提高对患者偏好的理解，以及讨论 CRC 检测是否会花费时间来提高对患者偏好的理解。
对一项比较 SDM 培训加提醒组与单独提醒组的试验进行二次分析。PCP 和他们的患者在就诊后完成了调查，以评估他们是否讨论了 CRC 检测、患者的检测偏好以及讨论 CRC 检测的时间。我们比较了患者和 PCP 的反应，计算了患者-医生二人组之间的偏好一致性。多水平模型测试了不同手臂或讨论 CRC 的时间对偏好一致性的影响。
确定了 382 对 PCP 和患者调查二人组。大多数二人组在是否讨论 CRC 检测方面达成一致（82%）。只有 52%的二人组在患者的偏好上达成一致。SDM 培训并没有影响 PCP 对偏好诊断的准确性（55%对 48%，p=0.22）。无论讨论的时间长短，当讨论 CRC 检测时，PCP 更有可能准确诊断患者的偏好。
只有一半的 PCP 准确识别出患者的检测偏好。培训没有影响准确性。讨论 CRC 检测的就诊使 PCP 更好地理解患者的偏好。
PCP 应该花时间讨论检测和了解患者的偏好。
