Physicians' Colorectal Cancer Screening Discussion and Recommendation Patterns
Physicians' Colorectal Cancer Screening Discussion and Recommendation Patterns
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DOI：
10.1158/1055-9965.epi-10-0749
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发表时间：
2011-03-01
影响因子：
3.8
通讯作者：
Kobrin, Sarah C.
中科院分区：
文献类型：
--
作者：
Zapka, Jane M.;Klabunde, Carrie N.;Kobrin, Sarah C.
背景资料：初级保健医生（PCP）的行动是结直肠癌（CRC）筛查性能的关键，指南建议与患者讨论测试选项和潜在的益处和危害。这篇文章简要介绍了关于筛查的讨论模式和建议，并探讨了与多水平因素的潜在关联（患者、临床医生、实践和环境）。2009年，我们分析了1,266名医生的数据，这些医生回答了2006-2007年全国初级保健医生对乳腺、宫颈、结直肠、肺癌筛查（绝对应答率69.3%，配合率75.0%）。描述性统计检查医生的讨论和建议的报告。多变量分析评估了这些做法与多层次factors.Results的关联：虽然很少有受访者报告的所有选项的讨论，46%通常讨论一个以上的选项，绝大多数这些受访者讨论粪便潜血试验（FOBT）和结肠镜检查（49%）或FOBT，乙状结肠镜检查，结肠镜检查（32%）。在讨论一种以上选择的医生中，大多数医生报告通常推荐一种或多种检查选择，最常见的是单独结肠镜检查（43%）和FOBT和结肠镜检查（43%）。几个人的特点（专业），感知病人的特点（喜欢医生决定），实践特点（地理位置），和社区的障碍（专家可用性）独立相关的讨论和/或建议patterns.Conclusions：PCP不讨论完整的菜单的测试选项，但许多报告选择一个或两个选项的讨论和建议。为了确保患者的观点和关注引起和考虑，患者的决策方法应考虑。影响：注意在CRC筛查知情决策将是重要的，以提高以患者为中心的优质护理。癌症流行病学生物标志物Prev; 20（3）; 509-21。（C）2011年《非洲标准化评论》。
Background: Primary care physician (PCP) actions are pivotal to colorectal cancer (CRC) screening performance, and guidelines recommend discussion with patients about test options and potential benefits and harms. This article profiles patterns of discussion about and recommendations for screening and explores potential associations with multilevel factors (patient, clinician, practice, and environment).Methods: In 2009, we analyzed data from 1,266 physicians responding to the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening (absolute response rate = 69.3%; cooperation rate = 75.0%). Descriptive statistics examined physicians' reports of discussion and recommendations. Multivariate analyses assessed the associations of these practices with multilevel factors.Results: Although few respondents reported discussion of all options, 46% usually discuss more than one option; the vast majority of these respondents discuss fecal occult blood testing (FOBT) and colonoscopy (49%) or FOBT, sigmoidoscopy, and colonoscopy (32%). Of physicians who discuss more than one option, a majority reported usually recommending one or more test options, most commonly colonoscopy alone (43%) and FOBT and colonoscopy (43%). Several personal characteristics (specialty), perceived patient characteristics (prefer physician to decide), practice characteristics (geographic location), and community barriers (specialist availability) were independently associated with discussion and/or recommendation patterns.Conclusions: PCPs do not discuss the full menu of test options, but many report selecting one or two options for discussion and recommendation. To ensure that patients' perspectives and concerns are elicited and considered, patient decision-making approaches should be considered.Impact: Attention to informed decision making in CRC screening will be important for enhancing patient-centered quality care. Cancer Epidemiol Biomarkers Prev; 20(3); 509-21. (C)2011 AACR.