Primary care physician recommendations for colorectal cancer screening. Patient and practitioner factors.
Primary care physician recommendations for colorectal cancer screening. Patient and practitioner factors.
复制标题
初级保健医生对结直肠癌筛查的建议。
DOI：
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发表时间：
1997
影响因子：
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通讯作者：
C. Landefeld
中科院分区：
文献类型：
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作者：
Gregory S. Cooper;R. Fortinsky;Ronald Hapke;C. Landefeld
背景
目前的结直肠癌筛查指南没有明确年龄或合并症在患者选择中的作用。因此，报告的筛查实践可能会受到患者以及医生特征的影响。
方法
向10个州的初级保健医生发送了一份问卷，以确定粪便潜血试验（FOBT）和乙状结肠镜检查在4对临床小插曲中的建议，这些临床小插曲因患者年龄（65或75岁）和合并症（无，轻度，中度和晚期）而异。
结果
在884名受访者中（50%），大多数医生建议FOBT在所有的小插曲，除了那些有绝症和不到一半的建议乙状结肠镜检查在任何小插曲。医生的建议受到合并症的影响，但三分之一的人仍然建议对绝症患者进行FOBT，不到50%的人建议对无合并症的患者进行乙状结肠镜检查。仅在患者年龄上不同的小插曲之间推荐的筛查差异很小。在所有的医生亚组中，至少有30%的医生建议对绝症患者进行FOBT，不超过60%的医生建议对健康患者进行乙状结肠镜检查。
结论
初级保健医生更有可能建议筛查FOBT比乙状结肠镜检查，无论患者和从业者的因素。虽然医生的建议受到患者合并症和年龄的影响，但他们经常在临床不适当的情况下推荐FOBT，并且在适当的情况下不推荐乙状结肠镜检查。可能需要采取基础广泛的干预措施，以改善适当的筛查做法。
BACKGROUND
Current guidelines for colorectal cancer screening do not specify the role of age or comorbidity in patient selection. Reported screening practices may thus be influenced by patient, as well as physician, characteristics.
METHODS
A questionnaire was sent to primary care physicians in 10 states to determine recommendations for fecal occult blood testing (FOBT) and sigmoidoscopy in 4 pairs of clinical vignettes that varied by patient age (65 or 75 years) and comorbidity (none, mild, moderate, and terminal).
RESULTS
Among the 884 respondents (50%), most physicians recommended FOBT in all vignettes except those with a terminal illness and fewer than half recommended sigmoidoscopy in any vignette. Physician recommendations were influenced by comorbidity, but one third still recommended FOBT for terminally ill patients and less than 50% recommended sigmoidoscopy for patients with no comorbidity. Differences in recommended screening between vignettes that differed only in patient age were small. Among all subgroups of physicians, at least 30% recommended FOBT in terminally ill patients and no more than 60% recommended sigmoidoscopy in healthy patients.
CONCLUSIONS
Primary care physicians were much more likely to recommend screening with FOBT than sigmoidoscopy, regardless of patient and practitioner factors. Although physician recommendations were influenced by patient comorbidity and age, they frequently recommended FOBT in clinically inappropriate settings and failed to recommend sigmoidoscopy when appropriate. Broad-based interventions to improve appropriate screening practices may be needed.