THE IMPORTANCE OF PHYSICIAN COMMUNICATION ON BREAST-CANCER SCREENING OF OLDER WOMEN
THE IMPORTANCE OF PHYSICIAN COMMUNICATION ON BREAST-CANCER SCREENING OF OLDER WOMEN
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DOI：
10.1001/archinte.154.18.2058
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发表时间：
1994-09-26
影响因子：
--
通讯作者：
STEIN, JA
中科院分区：
文献类型：
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作者：
FOX, SA;SIU, AL;STEIN, JA
背景：乳腺癌筛查率，特别是乳房x光检查，在老年妇女，特别是65岁以上的妇女中继续落后。方法：我们调查了972名年龄在50岁以上的女性样本中乳房x光检查和临床乳房检查报告率与关键变量的关系；其中724人年龄在65岁以上。他们在1990年末接受了30分钟的双语电话采访。结果：虽然假设种族、年龄、健康状况和医患沟通变量会影响使用率，但只有沟通变量（和两个访问变量）显著预测最近的乳房x光检查或临床乳房检查。特别是，沟通的方式——病人报告医生对乳房x光检查的热情时，在办公室访问的妇女讨论——显着影响妇女的筛查行为。那些认为自己的医生对乳房x光检查有一定热情的女性在前一年接受乳房x光检查的可能性是那些医生对乳房x光检查没有或很少热情的女性的4.5倍多。其他发现是，在这项研究中，加州洛杉矶约有一半的女性最近做过乳房x光检查，比1988年前一个月的三分之一有所增加；直到75岁以后，筛查率才有所下降。另一方面，尽管长期以来建议对50岁以上的女性进行定期筛查，而且患乳腺癌的风险随着年龄的增长而增加，但约有四分之一的研究女性从未接受过筛查。令人惊讶的是，乳腺癌风险较高的女性并没有比风险较低的女性接受更系统的筛查。结论：提高医患沟通技巧是提高整体筛查率的一种高效易学的策略。
Background: Breast cancer screening rates, especially for mammography, continue to lag for older women, particularly for women older than 65 years.Methods: We investigated the associations of key variables with reported rates of mammography and clinical breast examination in a sample of 972 women older than 50 years; 724 of them were older than 65 years. They were surveyed in late 1990 through 30-minute bilingual telephone interviews.Results: Although it was hypothesized that race, age, health status, and physician-patient communication variables would influence utilization rates, only the communication variables (and two access variables) significantly predicted a recent mammogram or clinical breast examination. Tn particular, the style of the communication-the patient's report of the physician's enthusiasm for mammography when it was discussed with women at the office visit-influenced the women's screening behavior significantly. Women who perceived that their physicians had some enthusiasm for mammography were more than four and a half times more likely than women whose physicians had no or little enthusiasm for mammography to have had one within the previous year. Other findings were that about half of the Los angeles, Calif, women in this study reported a recent mammogram, an increase from the one third who reported one in the previous sun ey of 1988; a decline in screening was not reported until after age 75 years. About a quarter of the study women, on the other hand, had never been screened despite the long-standing recommendation for regular screening of women older than 50 years and the risk of breast cancer increasing with age. Surprisingly, women at higher risk of breast cancer were not being screened any more systematically than women at lower risk.Conclusion: We conclude that improved physician-patient communication skills could be a highly effective and easy-to-learn strategy to increase overall screening rates.