Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians.
Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians.
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DOI：
10.2147/rmhp.s143152
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发表时间：
2017-01-01
影响因子：
3.5
通讯作者：
Reuland, Daniel S
中科院分区：
文献类型：
--
作者：
Henderson, Louise M;Jones, Laura M;Reuland, Daniel S
简介：美国预防服务工作组于 2013 年 12 月建议每年对高危患者进行低剂量计算机断层扫描 (LDCT) 肺癌筛查。我们比较了主治医生和住院初级保健医生 (PCP) 与肺癌筛查相关的意见和做法。方法：2015 年，我们在一家大型学术医疗中心的医生中进行了一项包含 23 项的调查。我们对家庭医学和内科领域的 100 名住院 PCP（答复率为 30%）和 86 名主治 PCP（答复率为 49%）进行了调查。问题集中于医生的意见、对建议的了解、自我报告的实践模式以及肺癌筛查的障碍。 2015 年和 2016 年，我们使用卡方/Fisher 精确检验和 2 样本 t 检验比较了主治 PCP 与常驻 PCP 的反应。 结果：与常驻 PCP 相比，主治 PCP 年龄更大（平均年龄 = 47 岁 vs 30 岁），而且更有可能是男性（54% vs 37%）。两组中超过一半的人都同意，不一致的建议使得决定是否进行筛查变得困难。两组中都有很大比例的人表示他们不确定肺癌筛查对患者的益处（43% 的主治 PCP 和 55% 的住院 PCP）。大多数主治和住院 PCP 认为筛查的障碍包括患者就诊时间有限（分别为 62% 和 78%）、患者费用（分别为 74% 和 83%）、潜在并发症（分别为 53% 和 70%）以及高假阳性率（分别为 67% 和 73%）。 结论：没有证据表明主治和住院 PCP 对肺癌筛查有不同意见。为了以人群为基础实施肺癌筛查，医生和学员将需要资源和时间来解决对患者的好处和危害。
INTRODUCTION: The US Preventive Services Task Force recommended annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients in December 2013. We compared lung cancer screening-related opinions and practices among attending and resident primary care physicians (PCPs).METHODS: In 2015, we conducted a 23-item survey among physicians at a large academic medical center. We surveyed 100 resident PCPs (30% response rate) and 86 attending PCPs (49% response rate) in Family Medicine and Internal Medicine. The questions focused on physicians' opinions, knowledge of recommendations, self-reported practice patterns, and barriers to lung cancer screening. In 2015 and 2016, we compared responses among attending versus resident PCPs using chi-square/Fisher's exact tests and 2-samples t-tests.RESULTS: Compared with resident PCPs, attending PCPs were older (mean age =47 vs 30 years) and more likely to be male (54% vs 37%). Over half of both groups concurred that inconsistent recommendations make deciding whether or not to screen difficult. A substantial proportion in both groups indicated that they were undecided about the benefit of lung cancer screening for patients (43% attending PCPs and 55% resident PCPs). The majority of attending and resident PCPs agreed that barriers to screening included limited time during patient visits (62% and 78%, respectively), cost to patients (74% and 83%, respectively), potential for complications (53% and 70%, respectively), and a high false-positive rate (67% and 73%, respectively).CONCLUSION: There was no evidence to suggest that attending and resident PCPs had differing opinions about lung cancer screening. For population-based implementation of lung cancer screening, physicians and trainees will need resources and time to address the benefits and harms with their patients.