Physician Nonprofessional Cancer Experience and Ovarian Cancer Screening Practices: Results from a National Survey of Primary Care Physicians
Physician Nonprofessional Cancer Experience and Ovarian Cancer Screening Practices: Results from a National Survey of Primary Care Physicians
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DOI：
10.1089/jwh.2018.6947
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发表时间：
2018-11-01
影响因子：
3.5
通讯作者：
Baldwin, Laura-Mae
中科院分区：
文献类型：
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作者：
Ragland, Margaret;Trivers, Katrina F.;Baldwin, Laura-Mae
目的：常规卵巢癌筛查效果不佳；因此，没有专业组织建议对无症状患者进行此项筛查。然而，许多医生建议进行筛查，使患者面临不必要的风险。关于癌症的非专业经验如何影响医生的筛查实践的研究很少。这项研究探讨了医生的非专业癌症经验与报告的卵巢癌筛查指南遵守情况之间的关联。材料和方法：向 3,200 名美国家庭医生、普通内科医生和妇产科医生随机抽取了一份邮寄调查问卷，其中包含年度检查小插曲和有关癌症筛查建议的问题。该分析包括 497 名医生，他们收到了具有平均卵巢癌风险的女性的小插图，并加权结果以代表全国范围内的这些医生群体。结果衡量标准是遵守卵巢癌筛查指南。逐步多元逻辑回归估计了指南遵守情况的调整风险比。结果：在未经调整的分析中，86.0% 没有非专业癌症经验的医生报告遵守了卵巢癌筛查指南，而有自己癌症病史或家庭成员或亲密朋友/同事患有癌症的医生的这一比例为 69.2% (p=0.0045)。在调整后的分析中，与没有非专业癌症经验的医生相比，患有癌症的医生本人或家庭成员或亲密朋友/同事报告遵守卵巢癌筛查建议的可能性要低 0.82 倍 (CI: 0.73-0.92)。结论：尽管有相反的建议，但许多医生报告建议对低风险女性进行卵巢癌筛查。与没有这种经验的医生相比，具有非专业癌症经验的医生更有可能报告提供或订购非推荐的筛查。
Objective: Routine ovarian cancer screening is ineffective; therefore, no professional organization recommends this screening in asymptomatic patients. However, many physicians have recommended screening, exposing patients to unnecessary risk. Little research exists on how nonprofessional experience with cancer influences physicians' screening practices. This study examines the association between physicians' nonprofessional experience with cancer and reported adherence to ovarian cancer screening guidelines. Materials and Methods: A mail questionnaire with an annual examination vignette and questions about cancer screening recommendations was sent to a random sample of 3,200 U.S. family physicians, general internists, and obstetrician-gynecologists. This analysis included 497 physicians who received a vignette of a woman at average ovarian cancer risk and weighted results to represent these physician groups nationally. The outcome measure was adherence to ovarian cancer screening guidelines. Stepwise multivariate logistic regression estimated adjusted risk ratios for guideline adherence. Results: In unadjusted analyses, 86.0% of physicians without nonprofessional cancer experience reported adherence to ovarian cancer screening guidelines compared with 69.2% of physicians with their own history of cancer, or a family member or close friend/coworker with cancer (p=0.0045). In adjusted analyses, physicians with cancer themselves or in a family member or close friend/coworker were 0.82 times less likely (CI: 0.73-0.92) to report adhering to ovarian cancer screening recommendations than those without nonprofessional cancer experience. Conclusions: Despite recommendations to the contrary, many physicians reported recommending ovarian cancer screening in low-risk women. Physicians with nonprofessional cancer experience were more likely to report offering or ordering nonrecommended screening than physicians without this experience.