Primary Care Provider Experience with Breast Density Legislation in Massachusetts
Primary Care Provider Experience with Breast Density Legislation in Massachusetts
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DOI：
10.1089/jwh.2017.6539
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发表时间：
2018-01-17
影响因子：
3.5
通讯作者：
Battaglia, Tracy A.
中科院分区：
文献类型：
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作者：
Gunn, Christine M.;Kressin, Nancy R.;Battaglia, Tracy A.
背景：乳腺X线摄影显示致密的乳房会独立增加乳腺癌的风险，并降低乳腺X线摄影的灵敏度。32个州已经通过了通知法，以提高乳腺致密妇女对补充筛查的认识。人们对这些政策对初级保健提供者（PCP）临床实践的影响知之甚少。材料与方法：本研究探讨了PCP的态度，知识，以及马萨诸塞州致密乳腺通知立法在2015年颁布后对临床实践的影响。2015-2016年，在两家城市安全网医院进行了一项匿名在线调查。执业医学博士和执业护士在初级保健被邀请参加。结果：所有145个PCP在普通内科在这两个网站通过电子邮件发送调查链接，80（55%）完成。虽然接受调查的80名PCP中有64名（80%）对立法有一定的了解，但没有一名PCP确定了马萨诸塞州立法中所载的8项必要通知内容。49%（39/80）的患者没有准备好回答患者有关致密乳房的问题。41%（33/80）的人正确地识别出目前没有任何指南建议仅根据乳腺密度进行补充筛查，85%（68/80）的人表示有兴趣进一步培训。女性和经验不足的供应商更有可能赞成立法（49%对11%按性别; 76% 20岁）。女性从业者（55%）比男性（17%，p=0.01）更有可能同意该政策，改变了他们与患者讨论乳房X光检查结果的方式。结论：PCP感到准备不足，以咨询妇女的乳房密度确定乳房X光检查及其影响。
Background: Dense breasts on mammography independently increases breast cancer risk and decreases mammography sensitivity. Thirty-two states have adopted notification laws to raise awareness among women with dense breasts about supplemental screening. Little is known about these policies' impact on clinical practice among primary care providers (PCPs). Materials and Methods: This study explores PCP attitudes, knowledge, and the impact of the Massachusetts dense breast notification legislation on clinical practice after its enactment in 2015. An anonymous, online survey at two urban safety-net hospitals was administered in 2015-2016. Practicing MDs and nurse practitioners in primary care were invited to participate. Results: All 145 PCPs in general internal medicine at the two sites were e-mailed a survey link and 80 (55%) were completed. While 64 of 80 PCPs surveyed (80%) had some familiarity with the legislation, none identified the 8 required components of notifications contained in the Massachusetts legislation. Forty-nine percent (39/80) did not feel prepared to respond to patient questions about dense breasts. Forty-one percent (33/80) correctly identified that no current guidelines recommend the use of supplemental screening tests solely based on breast density and 85% (68/80) indicated interest in further training. Female and less experienced providers were more likely to be in favor of the legislation (49% vs. 11% by gender; 76% 20 years). Women practitioners (55%) who were more likely than men (17%, p=0.01) to agree with the policy changed their discussions of mammography results with patients. Conclusions: PCPs feel underprepared to counsel women about breast density identified on mammography and its implications.