Are physicians discussing prostate cancer screening with their patients and why or why not? A pilot study
Are physicians discussing prostate cancer screening with their patients and why or why not? A pilot study
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DOI：
10.1007/s11606-007-0142-3
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发表时间：
2007-07-01
影响因子：
5.7
通讯作者：
Shea, Judy A.
中科院分区：
文献类型：
--
作者：
Guerra, Carmen E.;Jacobs, Samantha E.;Shea, Judy A.
背景：前列腺癌筛查(PCS)一直备受争议。理想情况下，患者应该在接受PSA检测之前了解筛查的风险和好处。这项研究评估了初级保健医生是否经常讨论PCS，并探索了这些讨论的障碍和促进者。方法：定性先导性研究，包括对18名有目的地抽样、学术和社区基础的初级保健医生进行深入的、半结构化的访谈。PCS讨论的障碍和促进者通过访谈和图表刺激回忆来确定-这是一种利用患者图表来探索回忆并为医生在临床会诊期间做出决策提供背景的技术。采用基于扎根理论技术的共识会议进行分析。结果：所有18名参与的医生都报告他们一般与患者讨论PCS，但6名医生报告有时在没有讨论的情况下安排PSA测试。在44个患者-医生的会诊中，只有16个(36%)发生了PCS的讨论，这些患者也符合图表刺激回忆的标准。讨论PCS的障碍是患者共病、有限的教育/健康素养、先前拒绝治疗、医生健忘、急诊和缺乏时间。PCS讨论的促进者包括患者要求的筛查、受过高等教育的患者、前列腺癌家族史、非裔美国人、常规体检、回顾既往PSA结果、会见期间的额外时间以及提醒系统。讨论的重要障碍是没有足够的时间维持健康，医生健忘，以及患者的特征。未来的研究应该探索使用教育和决策支持干预措施，让更多的患者参与PCS的决策。
Background: Prostate cancer screening (PCS) is controversial. Ideally, patients should understand the risks and benefits of screening before undergoing PSA testing. This study assessed whether primary care physicians routinely discuss PCS and explored the barriers to and facilitators of these discussions.Methods: Qualitative pilot study involving in-depth, semistructured interviews with 18 purposively sampled, academic and community-based primary care physicians. Barriers and facilitators of PCS discussions were ascertained using both interviews and chart-stimulated recall-a technique utilizing patient charts to probe recall and provide context to physician decision-making during clinic encounters. Analysis was performed using consensus conferences based on grounded theory techniques.Results: All 18 participating physicians reported that they generally discussed PCS with patients, though 6 reported sometimes ordering PSA tests without discussion. A PCS discussion occurred in only 16 (36%) of the 44 patient-physician encounters when patients were due for PCS that also met criteria for chart-stimulated recall. Barriers to PCS discussion were patient comorbidity, limited education/health literacy, prior refusal of care, physician forgetfulness, acute-care visits, and lack of time. Facilitators of PCS discussion included patient-requested screening, highly educated patients, family history of prostate cancer, African-American race, visits for routine physicals, review of previous PSA results, extra time during encounters, and reminder systems.Conclusions: PCS discussions sometimes do not occur. Important barriers to discussion are inadequate time for health maintenance, physician forgetfulness, and patient characteristics. Future research should explore using educational and decision support interventions to involve more patients in PCS decisions.