A Novel Curriculum on Using Life Expectancy to Inform Cancer Screening in Older Adults.
A Novel Curriculum on Using Life Expectancy to Inform Cancer Screening in Older Adults.
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DOI：
10.1111/jgs.17016
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发表时间：
2021-02
影响因子：
6.3
通讯作者：
Schoenborn, Nancy L.
中科院分区：
文献类型：
--
作者：
Ahmed, Shaista U.;Burke, Meg;McGuire, Maura;Massare, Jacqueline;Boyd, Cynthia M.;Pollack, Craig E.;Lentz, Caroline;Schoenborn, Nancy L.
许多预期寿命有限的老年人仍然接受癌症筛查。一个潜在的原因是初级保健提供者（PCP）没有接受过将预期寿命纳入癌症筛查建议的培训。我们描述了一个新的课程，以满足这一需求的开发和评估。我们开发并实施了一个基于网络的学习模块，在一个大型的马里兰州组的做法与老年人的PCP。我们评估了态度，知识，自我效能和自我报告的行为结果模块之前，完成模块后立即，6个月后。在172名被邀请的PCP中，86名（50%）完成了该模块，其中50名（58.1%）完成了6个月的随访调查。在模块之后，预期寿命的重要性有了显著的提高（在10分量表上增加0.50分，95%置信区间[CI] 0.27-0.73），预测预期寿命的信心（10分量表增加2.32分，95% CI 1.95- 2.70）和讨论筛选停止的置信度（10分量表增加1.69分，95% CI 1.37- 2.02）。患者首选沟通策略的知识从55%的正确回答提高到97%（p<0.001）。然而，这些改善大部分在6个月时消失，与基线相比，6个月时自我报告的行为没有变化（p=0.34）。虽然该单元在短期内显著改善了态度、知识和自我效能，但这些变化并没有随着时间的推移而持续。这样的教育干预措施可以与正在进行的强化策略和/或决策支持干预措施相结合，以改善老年人的癌症筛查实践。
Many older adults with limited life expectancy still receive cancer screening. One potential contributor is that primary care providers (PCP) are not trained to incorporate life expectancy in cancer screening recommendations. We describe the development and evaluation of a novel curriculum to address this need. We developed and implemented a web-based learning module within a large Maryland group practice with PCPs for older adults. We assessed attitude, knowledge, self-efficacy, and self-reported behavior outcomes before the module, immediately after completing the module, and 6 months afterwards. Of 172 PCPs who were invited, 86 (50%) completed the module and of these, 50 (58.1%) completed the 6-months follow up survey. Immediately after the module, there was a significant increase in perceived importance of life expectancy (increase of 0.50 point on 10-point scale, 95% Confidence Intervals [CI] 0.27-0.73), confidence in predicting life expectancy (increase of 2.32 points on 10-point scale, 95% CI 1.95- 2.70) and confidence in discussion screening cessation (increase of 1.69 points on 10-point scale, 95% CI 1.37- 2.02). Knowledge in patient-preferred communication strategies improved from 55% correct response to 97% (p<0.001). However, most of these improvements dissipated by 6-months and there was no change in self-reported behavior at 6-months compared to baseline (p=0.34). Although the module resulted in significant short-term improvement in attitude, knowledge and self-efficacy, the changes were not sustained over time. Educational interventions such as this can be coupled with ongoing reinforcing strategies and/or decision support interventions to improve cancer screening practices in older adults.
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DOI：
10.1001/jama.2015.12783
发表时间：
2015-10-20
期刊：
JAMA
影响因子：
--
作者：
Oeffinger KC;Fontham ET;Etzioni R;Herzig A;Michaelson JS;Shih YC;Walter LC;Church TR;Flowers CR;LaMonte SJ;Wolf AM;DeSantis C;Lortet-Tieulent J;Andrews K;Manassaram-Baptiste D;Saslow D;Smith RA;Brawley OW;Wender R;American Cancer Society
通讯作者：
American Cancer Society
影响因子：
7.7
作者：
Rex, Douglas K.;Boland, C. Richard;Robertson, Douglas J.
通讯作者：
Robertson, Douglas J.
影响因子：
39.2
作者：
Qaseem, Amir;Barry, Michael J.;Shekelle, Paul
通讯作者：
Shekelle, Paul
影响因子：
120.7
作者：
Sirovich, BE;Schwartz, LM;Woloshin, S
通讯作者：
Woloshin, S
影响因子：
4.4
作者：
Jerant, AF;Franks, P;Doescher, MP
通讯作者：
Doescher, MP