Patient preferences for colon cancer screening
Patient preferences for colon cancer screening
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DOI：
10.1046/j.1525-1497.1999.00018.x
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发表时间：
1999-07-01
影响因子：
5.7
通讯作者：
Harris, R
中科院分区：
文献类型：
--
作者：
Pignone, M;Bucholtz, D;Harris, R
目的：衡量患者对四种不同筛查策略的偏好：每年单独进行粪便潜血检查（FOBT）；单用柔性乙状结肠镜检查（FSIG）每5年一次；每年一次的FOBT和每5年一次的FSIG：或不进行筛查。设计:调查。单位：大学内科门诊。患者：方便样本为146名成人（年龄50-75岁），既往无结肠癌病史。干预：由训练有素的研究助理口头管理的结肠癌筛查三部分教育计划。测量方法和主要结果：患者对筛查的偏好在三个点进行测量：在关于结肠癌和筛查选择的描述性信息（测试程序信息）之后；获得有关测试性能的信息，但没有自付费用（测试性能信息）；最后是假设的自付费用（成本信息）。仅在描述性测试信息之后，最流行的策略是单独FOBT（45%）或两种测试（38%）。较少的患者选择单独使用FSIG（13%）。在了解测试表现后，更多的受试者更喜欢两种测试（47%），更少的受试者更喜欢单独的FOBT (36%) （p = .12）。假设自付费用，选择单独FOBT的比例增加到53%，而选择两种测试的比例下降到31% （p < 0.001）。不到5%的患者选择不进行筛查。结论：患者对结肠癌筛查的偏好对测试表现的信息适度敏感，对自付费用高度敏感。患者对如何筛查的偏好的异质性支持知情的共同决策作为改善结肠癌筛查的可能手段。
OBJECTIVE: To measure patient preferences for four different screening strategies: annual fecal occult blood testing (FOBT) alone; flexible sigmoidoscopy (FSIG) every 5 years alone; both annual FOBT and FSIG every 5 years: or no screening.DESIGN: Survey.SETTING: University internal medicine clinic.PATIENTS: Convenience sample of 146 adults (aged 50-75 years) with no previous history of colon cancer.INTERVENTION: Three-part educational program on colon cancer screening administered verbally by trained research assistants.MEASUREMENTS AND MAIN RESULTS: Patient preferences for screening were measured at three points: after descriptive information about colon cancer and screening options (testing procedure information); after information about test performance but with no out-of-pocket costs (test performance information); and finally with hypothetical out-of-pocket costs (cost information). After only descriptive test information, the most popular strategies were FOBT alone (45%) or both tests (38%). Fewer patients preferred FSIG alone (13%). After information about test performance, more subjects preferred both tests (47%), and fewer subjects preferred FOBT alone (36%) (p = .12). With hypothetical out-of-pocket costs, the proportion preferring FOBT alone increased to 53%, while those preferring both tests decreased to 31% (p < .001). Less than 5% of patients preferred no screening.CONCLUSIONS: Patient preferences for colon cancer screening were modestly sensitive to information about test performance and strongly sensitive to out-of-pocket costs. The heterogeneity of patients' preferences for how to be screened supports informed shared decision making as a possible means of improving colon cancer screening.