A Qualitative Analysis of Lung Cancer Screening Practices by Primary Care Physicians
A Qualitative Analysis of Lung Cancer Screening Practices by Primary Care Physicians
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DOI：
10.1007/s10900-011-9394-2
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发表时间：
2011-12-01
影响因子：
5.9
通讯作者：
Rohan, Elizabeth
中科院分区：
文献类型：
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作者：
Henderson, Susan;DeGroff, Amy;Rohan, Elizabeth
肺癌是美国癌症死亡的主要原因，但由于其有效性的证据有限，目前没有科学组织建议进行筛查。尽管如此，医生经常为他们的病人安排筛查测试，如胸部X光和计算机断层扫描。关于医生如何决定何时订购这些测试的信息有限。为了确定影响医生是否筛查肺癌患者的因素，我们与28名美国初级保健医生进行了5个75分钟的电话焦点小组，并使用归纳定性研究方法来分析他们的反应。我们确定了影响这些医生对肺癌患者进行筛查的决定的七个因素：（1）他们对筛查测试有效性的看法，（2）他们对推荐的筛查指南的态度，（3）他们的实践经验，（4）他们对患者患肺癌风险的看法，（5）筛查的报销和支付，（6）他们对诉讼的关注，以及（7）患者是否要求筛查。由于这些因素可能对医生决定进行筛查测试产生相互冲突的影响，医生可能会在确定何时进行肺癌筛查时遇到困难。我们建议（1）从医学院开始，对临床医生进行更多的教育，了解与肺癌筛查相关的现有证据，重点是烟草使用预防和戒烟的益处和培训，（2）对患者进行更多的教育，了解筛查的益处和局限性，（3）进一步研究患者要求筛查对医生决定进行筛查测试的影响，（4）更大规模的定量研究，以跟进我们的形成性数据。
Lung cancer is the leading cause of cancer death in the United States, but no scientific organization currently recommends screening because of limited evidence for its effectiveness. Despite this, physicians often order screening tests such as chest X-rays and computerized tomography scans for their patients. Limited information is available about how physicians decide when to order these tests. To identify factors that affect whether physicians' screen patients for lung cancer, we conducted five 75-min telephone-based focus groups with 28 US primary care physicians and used inductive qualitative research methods to analyze their responses. We identified seven factors that influenced these physicians' decisions about screening patients for lung cancer: (1) their perception of a screening test's effectiveness, (2) their attitude toward recommended screening guidelines, (3) their practice experience, (4) their perception of a patient's risk for lung cancer, (5) reimbursement and payment for screening, (6) their concern about litigation, and (7) whether a patient requested screening. Because these factors may have conflicting effects on physicians' decisions to order screening tests, physicians may struggle in determining when screening for lung cancer is appropriate. We recommend (1) more clinician education, beginning in medical school, about the existing evidence related to lung cancer screening, with emphasis on the benefit of and training in tobacco use prevention and cessation, (2) more patient education about the benefits and limitations of screening, (3) further studies about the effect of patients' requests to be screened on physicians' decisions to order screening tests, and (4) larger, quantitative studies to follow up on our formative data.