Variation in Eligible Patients' Agreeing to and Receiving Lung Cancer Screening: A Cohort Study.
Variation in Eligible Patients' Agreeing to and Receiving Lung Cancer Screening: A Cohort Study.
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DOI：
10.1016/j.amepre.2020.10.014
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发表时间：
2021-04
影响因子：
5.5
通讯作者：
Caverly, Tanner J.
中科院分区：
文献类型：
--
作者：
Leishman, N. Joseph;Wiener, Renda S.;Fagerlin, Angela;Hayward, Rodney A.;Lowery, Julie;Caverly, Tanner J.
关于临床医生如何在临床实践中做出低剂量计算机断层扫描肺癌筛查 (LCS) 决策，人们知之甚少。我们评估了与现实世界决策相关的因素，假设肺癌风险和合并症与实践中同意或接受筛查无关。尽管这些因素是濒海战斗舰效益的关键决定因素，但如果没有决策工具的帮助，它们通常很难纳入决策中。根据 8 个 VA 医疗机构在 2 年期间（2013-2015 年）完成的临床提示，对符合当前国家资格标准并被认为适合 LCS 候选者的患者进行回顾性队列研究。多级混合效应逻辑回归模型（2019-2020 年进行）评估了同意和接受筛查的主要结果的预测因素（年龄、性别、肺癌风险、查尔森指数、到 VA 设施的旅行距离以及中心与边远决策位置）。在 5,551 名患者（平均年龄 67 岁；97% 为男性；平均肺癌风险 0.7%；平均查尔森指数 1.14；中位旅行距离 24.2 英里）中，3,720 名患者 (67%) 同意接受 LCS，2,398 名患者 (43%) 接受了筛查。肺癌风险和合并症评分并不是同意或接受 LCS 的强预测因素。根据经验贝叶斯调整，各机构同意并接受 LCS 的比例为 22%-84%，临床医生的同意和接受 LCS 的比例为 19%-85%。 33.7% 的同意差异和 34.2% 的接受 LCS 差异与提供筛查的机构或临床医生有关。在退伍军人管理局濒海战斗舰示范项目期间，退伍军人同意并接受濒海战斗舰的情况存在很大差异。这种差异不能用患者受益的关键决定因素的差异来解释，而为患者提供建议的设施和临床医生对 LCS 决策有很大影响。
Little is known about how clinicians make low-dose computed tomography lung cancer screening (LCS) decisions in clinical practice. We assessed factors associated with real-world decision making, hypothesizing that lung cancer risk and comorbidity would not be associated with agreeing to or receiving screening in practice. Even though these factors are key determinants of the benefit of LCS, they are often difficult to incorporate into decisions without the aid of decision tools. Retrospective cohort study of patients meeting current national eligibility criteria and deemed appropriate candidates for LCS, based on clinical reminders completed over a 2-year period (2013-2015) at 8 VA medical facilities. Multilevel mixed-effects logistic regression models (conducted 2019-2020) assessed predictors (age, gender, lung cancer risk, Charlson Index, travel distance to VA facility, and central vs outlying decision making location) of primary outcomes of agreeing to and receiving screening. Of 5,551 patients (mean age 67; 97% male; mean lung cancer risk 0.7%; mean Charlson Index 1.14; median travel distance 24.2 miles), 3,720 (67%) agreed to LCS and 2,398 (43%) received screening. Lung cancer risk and comorbidity score were not strong predictors of agreeing to or receiving LCS. Empirical Bayes adjusted rates of agreeing to and receiving LCS ranged from 22%-84% across facilities, and 19%-85% across clinicians. 33.7% of the variance in agreeing-to and 34.2% of the variance in receiving LCS was associated with the facility or the clinician offering screening. Substantial variation in Veterans agreeing to and receiving LCS during the VA LCS Demonstration Project was found. This variation wasn’t explained by differences in key determinants of patient benefit, while the facility and clinician advising the patient had a large impact on LCS decisions.
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影响因子：
3.8
作者：
Partin, Melissa R.;Burgess, Diana J.;Nelson, David B.
通讯作者：
Nelson, David B.
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
DOI：
10.1164/rccm.201805-0986st
发表时间：
2018-07-15
影响因子：
24.7
作者：
Rivera, M. Patricia;Tanner, Nichole T.;Wiener, Renda Soylemez
通讯作者：
Wiener, Renda Soylemez
影响因子：
3
作者：
Bannay, Aurelie;Chaignot, Christophe;Alla, Francois
通讯作者：
Alla, Francois
影响因子：
5.3
作者：
Cutler, David;Skinner, Jonathan S.;Wennberg, David
通讯作者：
Wennberg, David