Costanza M E, Hoople N E, Gaw V P, Stoddard A M
Department of Medicine, University of Massachusetts, Worcester 01655.
Am J Prev Med. 1993 Mar-Apr;9(2):107-12.
We surveyed 1,500 primary care physicians in Massachusetts regarding their current attitudes and practices, as well as their interests and preferences in regard to a continuing education course, in cancer prevention and screening. Thirty-three percent (n = 488) of physicians returned questionnaires, with equal distribution among internists, family practitioners, and gynecologists. Our findings are based on physicians' self-report: 80%-92% of physicians routinely perform or order breast, cervical, skin, prostate, and colon examinations (with the exception of proctoscopy) for asymptomatic patients 50 years of age and older. Perceived barriers reported were as follows: for mammography, patient age older than 75; for sigmoidoscopy, cost; for counseling, lack of educational materials. Ninety-one percent of physicians rated a comprehensive course on cancer detection and prevention emphasizing practical matters and offering opportunity to upgrade clinical skills in physical exam and in counseling as somewhat to very useful. Specific topic preferences varied by specialty, but first preference for all three primary care groups was a course in improving their office management of cancer prevention and screening activities. Most appealing to practitioners was a one-day course leading to accreditation in screening and prevention and to reduction in malpractice premiums.
我们就马萨诸塞州1500名初级保健医生对癌症预防与筛查的当前态度和做法、以及他们对一门继续教育课程的兴趣和偏好展开了调查。33%（n = 488）的医生返回了问卷，内科医生、家庭医生和妇科医生的问卷回收率相当。我们的研究结果基于医生的自我报告：80%-92%的医生会定期为50岁及以上无症状患者进行或安排乳房、宫颈、皮肤、前列腺和结肠检查（直肠镜检查除外）。报告的感知障碍如下：对于乳房X光检查，患者年龄超过75岁；对于乙状结肠镜检查，费用问题；对于咨询，缺乏教育材料。91%的医生认为一门关于癌症检测与预防的综合课程强调实际问题并提供提升体格检查和咨询临床技能的机会，有点用处或非常有用。具体的主题偏好因专业而异，但所有三个初级保健群体的首要偏好都是一门关于改善其办公室癌症预防与筛查活动管理的课程。对从业者最有吸引力的是一门为期一天的课程，该课程可获得筛查与预防认证，并降低医疗事故保险费。
