Opinions and Practices of Lung Cancer Screening by Physician Specialty.
Opinions and Practices of Lung Cancer Screening by Physician Specialty.
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DOI：
10.18043/ncm.80.1.19
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发表时间：
2019-01-01
影响因子：
--
通讯作者：
Rivera, M Patricia
中科院分区：
文献类型：
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作者：
Henderson, Louise M;Marsh, Mary W;Rivera, M Patricia
作为对国家肺筛查试验的回应，许多专业组织发表了指南，建议对高危患者进行低剂量计算机断层扫描（LDCT）的年度肺癌筛查。先前的研究发现，医生的态度和知识，肺癌筛查直接影响的筛查examinesordered.METHODS的数量在2015年，我们调查了34肺科医生和186初级保健提供者（PCP），以评估意见和做法的肺癌筛查在一个大型学术医疗中心。我们比较了PCP和肺科医生的反应，采用t检验和卡方检验。结果总体调查的反应率为40%（39%的PCP和50%的肺科医生）。肺科医生比PCP更可能报告肺癌筛查对患者有益（88.2%对37.7%，P <0.0001），并具有成本效益（47.1%对14.3%，P = 0.02）。与PCP（41%，P = 0.012）相比，更多的肺病学家（76%）报告在过去12个月内订购了LDCT进行筛查。肺病学家和PCP报告了将患者转诊进行肺癌筛查的类似障碍，包括患者费用（82.4%对77.8%），潜在的情感伤害（58.8%对58.3%），假阳性率高（47.1%对69.4%），以及医疗并发症的可能性（47.1%对59.7%）。局限性我们的结果可推广到学术医学中心，并且响应可能容易受到回忆偏差，无响应偏差，结论：我们发现PCP和肺科医生在肺癌筛查转诊和感知益处方面的意见和做法存在显着差异。随着肺癌筛查在临床实践中的不断出现，重要的是要了解提供者专业之间的这些差异，以确保筛查得到实施并适当地提供给患者。
BACKGROUND In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients. Prior studies found that physician attitudes and knowledge about lung cancer screening directly impacts the number of screening exams ordered.METHODS In 2015, we surveyed 34 pulmonologists and 186 primary care providers (PCPs) to evaluate opinions and practices of lung cancer screening in a large academic medical center. We compared PCP and pulmonologist responses using t-tests and chi2 tests.RESULTS The overall survey response rate was 40% (39% for PCPs and 50% for pulmonologists). Pulmonologists were more likely than PCPs to report lung cancer screening as beneficial for patients (88.2% versus 37.7%, P < .0001) and as being cost-effective (47.1% versus 14.3%, P = .02). More pulmonologists (76%) reported ordering a LDCT for screening in the past 12 months compared to PCPs (41%, P = .012). Pulmonologists and PCPs reported similar barriers to referring patients for lung cancer screening, including patient costs (82.4% versus 77.8%), potential for emotional harm (58.8% versus 58.3%), high false positive rate (47.1% versus 69.4%), and likelihood for medical complications (47.1% versus 59.7%).LIMITATIONS Our results are generalizable to academic medical centers and responses may be susceptible to recall bias, non-response bias, and social desirability bias.CONCLUSION We found significant differences in opinions and practices between PCPs and pulmonologists regarding lung cancer screening referrals and perceived benefits. As lung cancer screening continues to emerge in clinical practice, it is important to understand these differences across provider specialty to ensure screening is implemented and offered to patients appropriately.