Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
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DOI：
10.2147/ijgm.s153887
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发表时间：
2018
影响因子：
2.3
通讯作者：
Sheridan SL
中科院分区：
文献类型：
--
作者：
Kistler CE;Vu M;Sutkowi-Hemstreet A;Gizlice Z;Harris RP;Brewer NT;Lewis CL;Dolor RJ;Barclay C;Sheridan SL
初级保健提供者可能有助于使用低价值的癌症筛查。我们试图研究在哪些情况下初级保健提供者会讨论并推荐两种类型的癌症筛查服务，包括净收益范围和已知影响筛查的其他因素。这是一项对美国24家初级保健诊所126名初级保健提供者的横断面调查。参与者完成了两种假设的前列腺癌或结直肠癌（CRC）筛查方案的调查。不同情况下的患者因年龄和筛查要求状态而异。对于每种情况，提供者表示他们是否会讨论和建议筛查。提供者还报告了他们的筛查态度和其他已知影响筛查的因素（患者就诊时间短、担心诉讼、临床提醒/绩效指标和筛查指南）的影响。我们研究了提供者的态度和他们对假设的90岁老人（最低价值的筛查）的筛查建议之间的关系。提供者报告说，他们讨论癌症筛查的次数比推荐的次数要多（P<0.001）。与前列腺癌相比，更多的医生会讨论和推荐结直肠癌筛查（P<0.001），年轻患者比年长患者（P<0.001），当患者要求时比不要求时（P<0.001）。对于一名90岁的患者，癌症特异性筛查态度每增加1分，推荐筛查的可能性就会增加（前列腺癌30%，结直肠癌30%）。虽然大多数提供者报告的实践模式与净收益一致，但一些提供者会讨论并推荐低价值的癌症筛查，特别是在面对患者要求时。似乎需要更多的工作来帮助提供者讨论和推荐符合价值的筛查。
Primary-care providers may contribute to the use of low-value cancer screening. We sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. This was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers’ attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening). Providers reported they would discuss cancer screening more often than they would recommend it (P<0.001). More providers would discuss and recommend screening for CRC than prostate cancer (P<0.001), for younger than older patients (P<0.001), and when the patient requested it than when not (P<0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC). While most providers’ reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request. More work appears to be needed to help providers to discuss and recommend screening that aligns with value.