Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems.
Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems.
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DOI：
10.1158/1940-6207.capr-20-0109
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Corley DA
中科院分区：
文献类型：
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作者：
Ghai NR;Jensen CD;Merchant SA;Schottinger JE;Lee JK;Chubak J;Kamineni A;Halm EA;Skinner CS;Haas JS;Green BB;Cannizzaro NT;Schneider JL;Corley DA
初级保健提供者(PCP)对结直肠癌(CRC)筛查测试有效性的认知以及他们对测试间隔的建议影响患者筛查的接受度。很少有大型研究检查提供者的看法和建议，包括它们与表明可比测试有效性的证据和筛查频率的指南建议的一致性。4个医疗保健系统的提供者(n=1 281)在2017-2018年完成了一项调查，内容是他们对测试有效性的看法，以及针对40-49岁、50-74岁和≥75岁的患者进行结肠镜检查和粪便免疫化学测试(FIT)的建议间隔。对于50-74岁(符合筛查条件)的患者，82.9%的提供者认为结肠镜检查非常有效，而59.6%的提供者认为FIT，26.3%的提供者认为结肠镜检查比FIT更有效。此外，对于这个年龄段，77.9%的人建议每10年进行一次结肠镜检查，92.4%的人建议每年进行一次结肠镜检查。对于40-49岁和≥75岁的患者，超过三分之一的提供者认为这些测试在某种程度上或非常有效，尽管>；80%的人通常不建议对这些年龄段的患者进行这两种测试中的任何一种。供应商筛查试验间隔建议一般与CRC指南一致；然而，25%的供应商认为结肠镜检查比适合降低死亡率更有效，这与一些模拟研究表明可比的有效性不同。后一项发现可能会对卫生系统产生影响，因为在卫生系统中，Fit是主要的筛查策略。只有三分之一的提供者报告认为这些筛查测试对年轻和老年患者(即50岁和≥75岁)有效。如果癌症筛查建议被修改为包括年龄较大和/或较年轻的患者，那么针对这些信念的证据可能是相关的。
Primary care provider (PCP) perceptions of colorectal cancer (CRC) screening test effectiveness and their recommendations for testing intervals influence patient screening uptake. Few large studies have examined providers’ perceptions and recommendations, including their alignment with evidence suggesting comparable test effectiveness and guideline recommendations for screening frequency. Providers (n=1281) within 4 healthcare systems completed a survey in 2017–2018 regarding their perceptions of test effectiveness and recommended intervals for colonoscopy and fecal immunochemical testing (FIT) for patients ages 40–49, 50–74, and ≥75 years. For patients 50–74 (screening eligible), 82.9% of providers rated colonoscopy as very effective versus 59.6% for FIT, and 26.3% rated colonoscopy as more effective than FIT. Also, for this age group, 77.9% recommended colonoscopy every 10 years and 92.4% recommended FIT annually. For patients ages 40–49 and ≥75, over one-third of providers believed the tests were somewhat or very effective, although >80% did not routinely recommend screening by either test for these age groups. Provider screening test interval recommendations generally aligned with CRC guidelines; however, 25% of providers believed colonoscopy was more effective than FIT for mortality reduction, which differs from some modeling studies that suggest comparable effectiveness. The latter finding may have implications for health systems where FIT is the dominant screening strategy. Only one-third of providers reported believing these screening tests were effective in younger and older patients (i.e., <50 and ≥75 years). Evidence addressing these beliefs may be relevant if cancer screening recommendations are modified to include older and/or younger patients.