Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer
Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer
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DOI：
10.1007/s11606-014-3113-5
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发表时间：
2015-03-01
影响因子：
5.7
通讯作者：
Wilkes, Michael S.
中科院分区：
文献类型：
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作者：
Bell, Robert A.;McDermott, Haley;Wilkes, Michael S.
许多初级保健医生（PCP）是装备不良，以提供遗传性乳腺癌的筛查和咨询，以评估结果的互动网络为基础的遗传学课程与文本课程的初级保健医生。随机两组设计。121加州和宾夕法尼亚州的社区医生。基于网络的互动遗传学课程，对控制组的医生谁研究遗传学评论文章进行评估。教育结束后，医生与一名有遗传性乳腺癌风险的标准化患者（SP）进行互动，对访问讨论的记录进行编码，以确定是否存在与遗传性乳腺癌相关的69个主题。在所有医生中，病史采集、测试结果影响的讨论以及伦理和法律的问题的探索都是不完整的。大约一半的医生提供遗传咨询转介（54.6%），更少的医生（43.8%）推荐检测。干预医生比对照组更有可能探索遗传咨询的好处（78.3%对60.7%，P = 0.048），鼓励在检测前进行遗传咨询（38.3%与21.3%，P = 0.048），询问前列腺癌家族史（25.0%对6.6%，P = 0.006），并报告阳性结果表明男性亲属患前列腺癌的风险增加（20.0%对1.6%，P = 0.001）。干预组的医生比对照组更不可能询问德系犹太人的遗产（13.3%对34.4%，P = 0.01），或者当被问到“你会怎么做？“（33.3%对54.1%，P = 0.03）。医生很少进行关键的咨询行为，无论他们是否完成了基于网络的互动培训或阅读临床评论，这都是真实的。
Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer.To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians.Randomized two-group design.121 California and Pennsylvania community physicians.Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer.Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer.Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6 %), and fewer (43.8 %) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3 % versus 60.7 %, P = 0.048), encourage genetic counseling before testing (38.3 % versus 21.3 %, P = 0.048), ask about a family history of prostate cancer (25.0 % versus 6.6 %, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0 % versus 1.6 %, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3 % versus 34.4 %, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3 % versus 54.1 %, P = 0.03).Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.