Engaging Patients in Decisions About Cancer Screening: Exploring the Decision Journey Through the Use of a Patient Portal.
Engaging Patients in Decisions About Cancer Screening: Exploring the Decision Journey Through the Use of a Patient Portal.
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DOI：
10.1016/j.amepre.2017.10.027
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发表时间：
2018-03
影响因子：
5.5
通讯作者：
Longo DR
中科院分区：
文献类型：
--
作者：
Woolf SH;Krist AH;Lafata JE;Jones RM;Lehman RR;Hochheimer CJ;Sabo RT;Frosch DL;Zikmund-Fisher BJ;Longo DR
让患者做出明智的选择是至关重要的，但在繁忙的实践中很难做到。本研究旨在吸引临床环境之外的患者，以更好地了解他们如何做出癌症筛查决定，包括他们的主要关注点和最终决定的偏好。12家初级保健诊所为患者提供在线个人健康记录，邀请符合条件的患者完成17个项目的在线互动模块。在11458名注册用户中，完成该模块的邀请分别发送给了年龄在50-74岁、未进行结直肠癌筛查的成年人，以及年龄在40-49岁、年龄在55-69岁、近期未进行乳房x光检查或前列腺特异性抗原检测的男性。该模块由2355名患者启动，903名患者完成。大多数受访者（76.8%）知道自己有资格接受筛查。首选的下一步是与临床医生交谈（76.6%），阅读/研究（28.6%），咨询可信赖的朋友/家人（16.4%）。优先主题包括筛查在多大程度上提高了预期寿命、比较测试表现以及癌症的患病率/健康风险。最令人担心的是癌症/延迟检测（79.2%），异常结果（40.5%）和检测并发症（39.1%），最后是指错误的检测结果、医疗并发症或不必要的治疗。符合前列腺特异性抗原筛查条件的男性比符合乳房x光检查条件的女性更有可能表达对检测并发症的担忧，并优先权衡利弊而不是肠道感觉（p<0.05）。虽然这个样本倾向于筛选，但大多数患者在最终决定时需要帮助。许多人想权衡利弊，并对筛查的潜在危害表示担忧。了解患者如何做出决定可能有助于设计更有效的参与策略。
Engaging patients to make informed choices is paramount but difficult in busy practices. This study sought to engage patients outside the clinical setting to better understand how they approach cancer screening decisions, including their primary concerns and their preferences for finalizing their decision. Twelve primary care practices offering patients an online personal health record invited eligible patients to complete a 17-item online interactive module. Among 11,458 registered users, invitations to complete the module were sent to adults aged 50–74 years who were overdue for colorectal cancer screening and to women aged 40–49 years and men aged 55–69 who had not undergone a recent mammogram or prostate-specific antigen test, respectively. The module was started by 2,355 patients and completed by 903 patients. Most respondents (76.8%) knew they were eligible for screening. Preferred next steps were talking to the clinician (76.6%), reading/research (28.6%), and consulting trusted friends/family (16.4%). Priority topics included how much screening improves life expectancy, comparative test performance, and the prevalence/health risks of the cancer. Leading fears were getting cancer/delayed detection (79.2%), abnormal results (40.5%), and testing complications (39.1%), the last referring to false test results, medical complications, or unnecessary treatments. Men eligible for prostate-specific antigen screening were more likely than women eligible for mammography to express concerns about testing complications and to prioritize weighing pros and cons over gut feelings (p<0.05). Although this sample was predisposed to screening, most patients wanted help in finalizing their decision. Many wanted to weigh the pros and cons and expressed fears of potential harms from screening. Understanding how patients approach decisions may help design more effective engagement strategies.
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影响因子：
3.8
作者：
Flocke, Susan A.;Stange, Kurt C.;Lafata, Jennifer Elston
通讯作者：
Lafata, Jennifer Elston
影响因子：
3.5
作者：
Blanc X;Collet TH;Auer R;Fischer R;Locatelli I;Iriarte P;Krause J;Légaré F;Cornuz J
通讯作者：
Cornuz J
影响因子：
4.4
作者：
Epstein, Ronald M.;Street, Richard L., Jr.
通讯作者：
Street, Richard L., Jr.
影响因子：
120.7
作者：
Braddock, CH;Edwards, KA;Levinson, W
通讯作者：
Levinson, W
影响因子：
7.6
作者：
Gasper, K;Clore, GL
通讯作者：
Clore, GL