Qualitative analysis of shared decision-making for chemoprevention in the primary care setting: provider-related barriers.
Qualitative analysis of shared decision-making for chemoprevention in the primary care setting: provider-related barriers.
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初级保健环境中化学预防共同决策的定性分析：提供者相关障碍。
DOI：
10.1186/s12911-022-01954-y
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发表时间：
2022-08-04
影响因子：
3.5
通讯作者：
Crew, Katherine D.
中科院分区：
文献类型：
--
作者：
Jones, Tarsha;Silverman, Thomas;Guzman, Ashlee;McGuinness, Julia E.;Trivedi, Meghna S.;Kukafka, Rita;Crew, Katherine D.
在随机对照试验中，抗雌激素（如他莫昔芬、雷洛昔芬或芳香酶抑制剂）的化学预防已被证明可降低乳腺癌风险;然而，乳腺癌高危女性的摄入量仍然很低。本研究的目的是确定供应商相关的障碍，共同决策（SDM）的化学预防在初级保健环境。初级保健提供者（PCP）和有资格进行化学预防的高危妇女参加了一项试点研究和一项基于网络的决策支持工具的随机临床试验，以增加化学预防的吸收。PCP包括内科医生，家庭医生和妇科医生，而患者是高危女性，年龄35-75岁，根据Gail模型，5年浸润性乳腺癌风险≥ 1.67%。本研究纳入了7名高危妇女及其PCP的临床接触，这些妇女获得了这些决策支持工具。录音的临床遭遇逐字转录和分析使用扎根理论方法。6名初级保健提供者，其中4名为男性（平均年龄36岁[SD 6.5]），2名为女性（平均年龄39岁，[SD 11.5]），7名不同种族/民族的高风险女性患者参加了本研究。定性分析揭示了三个主题：（1）在临床相遇的竞争需求;（2）缺乏知识的供应商之间的化学预防;和（3）有限的风险沟通在临床相遇。在PCP中确定了SDM关于化学预防的关键障碍。提供者需要通过决策支持工具进行教育和资源，以便与高风险患者进行风险沟通和SDM，并在初级保健环境中获得处方化学预防的信心。 在线版本包含补充材料，可通过10.1186/s12911-022-01954-y获得。
Chemoprevention with anti-estrogens, such as tamoxifen, raloxifene or aromatase inhibitors, have been shown to reduce breast cancer risk in randomized controlled trials; however, uptake among women at high-risk for developing breast cancer remains low. The aim of this study is to identify provider-related barriers to shared decision-making (SDM) for chemoprevention in the primary care setting. Primary care providers (PCPs) and high-risk women eligible for chemoprevention were enrolled in a pilot study and a randomized clinical trial of web-based decision support tools to increase chemoprevention uptake. PCPs included internists, family practitioners, and gynecologists, whereas patients were high-risk women, age 35–75 years, who had a 5-year invasive breast cancer risk ≥ 1.67%, according to the Gail model. Seven clinical encounters of high-risk women and their PCPs who were given access to these decision support tools were included in this study. Audio-recordings of the clinical encounters were transcribed verbatim and analyzed using grounded theory methodology. Six primary care providers, of which four were males (mean age 36 [SD 6.5]) and two were females (mean age 39, [SD 11.5]) and seven racially/ethnically diverse high-risk female patients participated in this study. Qualitative analysis revealed three themes: (1) Competing demands during clinical encounters; (2) lack of knowledge among providers about chemoprevention; and (3) limited risk communication during clinical encounters. Critical barriers to SDM about chemoprevention were identified among PCPs. Providers need education and resources through decision support tools to engage in risk communication and SDM with their high-risk patients, and to gain confidence in prescribing chemoprevention in the primary care setting. The online version contains supplementary material available at 10.1186/s12911-022-01954-y.
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