Cooper G S, Fortinsky R H, Hapke R, Landefeld C S
Department of Medicine, University Hospitals of Cleveland and Cleveland VAMC, Case Western Reserve University, Ohio 44106, USA.
Cancer. 1998 Apr 15;82(8):1476-81.
Despite current recommendations of flexible sigmoidoscopy as a screening test for the detection of colorectal carcinoma, relatively few asymptomatic patients undergo this procedure. To enhance the use of sigmoidoscopy, differences in the use of screening, as well as barriers to screening among specific physician groups, should be defined.
The authors surveyed 1762 practicing primary care physicians to determine their self-reported ability to perform sigmoidoscopy and perceived obstacles to either initiating or enhancing screening.
A total of 884 physicians (50%) responded. Ninety percent of primary care physicians reported that they offered sigmoidoscopic screening to their patients, with 46% referring patients and 44% performing the procedure themselves. Physician characteristics were not associated with the overall use of sigmoidoscopy. In contrast, compared with physicians who referred patients for the procedure, physicians who performed sigmoidoscopy themselves were more often board certified, male, and graduated from medical school after 1970 (P < 0.001). In a multivariate analysis, these characteristics were also independently associated with the ability to perform sigmoidoscopy. The barrier to sigmoidoscopy cited most often was poor patient acceptance, whether or not the physician performed or referred patients for sigmoidoscopic screening. Other barriers cited were lack of training, lack of equipment, and time required, each of which was identified most often by physicians who did not screen at all.
Most physicians surveyed reported using sigmoidoscopic screening to some degree in their practice, although many did not perform the procedure themselves. Population-based interventions to increase screening may benefit from targeting specific physician subgroups and attempting to improve patient acceptance of the procedure.
尽管目前推荐使用乙状结肠镜检查作为筛查结直肠癌的方法，但相对较少的无症状患者接受该检查。为了提高乙状结肠镜检查的使用率，应明确筛查使用方面的差异以及特定医生群体在筛查方面的障碍。
作者对1762名执业初级保健医生进行了调查，以确定他们自我报告的进行乙状结肠镜检查的能力以及开展或加强筛查的感知障碍。
共有884名医生（50%）做出了回应。90%的初级保健医生报告称他们为患者提供乙状结肠镜筛查，其中46%将患者转诊，44%自己进行该检查。医生的特征与乙状结肠镜检查的总体使用情况无关。相比之下，与将患者转诊进行该检查的医生相比，自己进行乙状结肠镜检查的医生更常获得委员会认证、为男性且于1970年后从医学院毕业（P<0.001）。在多变量分析中，这些特征也与进行乙状结肠镜检查的能力独立相关。无论医生是否进行乙状结肠镜筛查或转诊患者，最常被提及的乙状结肠镜检查障碍是患者接受度差。其他被提及的障碍包括缺乏培训、缺乏设备和所需时间，其中每一项最常被根本不进行筛查的医生提及。
大多数接受调查的医生报告称在其临床实践中在一定程度上使用乙状结肠镜筛查，尽管许多医生自己不进行该检查。基于人群的增加筛查的干预措施可能受益于针对特定的医生亚组并试图提高患者对该检查的接受度。
