Interviews with primary care physicians regarding taking and interpreting the cancer family history
Interviews with primary care physicians regarding taking and interpreting the cancer family history
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DOI：
10.1093/fampra/cmn053
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发表时间：
2008-10-01
期刊：
影响因子：
2.2
通讯作者：
Flynn, Brian S.
中科院分区：
文献类型：
--
作者：
Wood, Marie E.;Stockdale, Alan;Flynn, Brian S.
背景。癌症家族史可用于对风险进行分层并指导癌症筛查和预防的管理。 目的。当前的研究旨在了解初级保健医生获取和使用癌症家族史的具体障碍。方法。对东北部两个州三个地区的家庭医学、普通内科和妇科专家的结构化样本进行了访谈。医学人类学家根据主题大纲进行采访；研究小组对成绩单进行了系统分析，以确定参与者表达的主要主题。结果。受访的40名城乡医生中，40%是女性，医学院毕业年份为1963年至2000年。这些医生重视癌症家族史，但过程和内容不规范。更集中地使用这些信息的主要障碍包括患者家族史知识的限制；需要时间来澄清和解释这些信息，并且缺乏清晰且易于理解的指南来协助普通、中度和高风险患者的收集、解释和管理决策。语言和文化障碍使得在某些人群中收集家族史变得更加困难。结论。有效应用癌症家族史信息的障碍包括患者家族史信息的局限性；缺乏系统、有效地关注最有用信息的方法，也缺乏风险分层和管理的可用指导。结果表明，需要支持解决这些问题，以更好地利用几个现成的癌症风险管理机会。
Background. The cancer family history can be used to stratify risk and guide management regarding screening and prevention of cancer.Objective. The current study was designed to gain understanding of specific barriers to obtaining and using the cancer family history for the primary care physician.Methods. Interviews were conducted with structured samples of specialists in family medicine, general internal medicine and gynaecology in three settings in two north-eastern states. A medical anthropologist conducted interviews based on a topical outline; transcripts were systematically analyzed by a research team to identify major themes expressed by participants.Results. Among 40 urban, suburban and rural physicians interviewed, 40% were women and medical school graduation years ranged from 1963 to 2000. These physicians regarded cancer family history as important, but process and content were not standardized. Major barriers to more focused use of this information included limitations of patients' family history knowledge; time needed to clarify and interpret this information and the lack of clear and accessible guidelines to assist in collection, interpretation and management decisions for average, moderate and higher risk patients. Language and cultural barriers made it more difficult to collect family histories in some populations.Conclusions. Barriers to effective application of cancer family history information included limitations of patients' family history information; lack of methods to systematically and efficiently focus on the most useful information and lack of accessible guidance for risk stratification and management. Results suggest a need for support addressing these concerns to better utilize several readily available cancer risk management opportunities.