Multiple Clinical Practice Guidelines for Breast and Cervical Cancer Screening Perceptions of US Primary Care Physicians
Multiple Clinical Practice Guidelines for Breast and Cervical Cancer Screening Perceptions of US Primary Care Physicians
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DOI：
10.1097/mlr.0b013e318202858e
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发表时间：
2011-02-01
期刊：
影响因子：
3
通讯作者：
Taplin, Stephen H.
中科院分区：
文献类型：
--
作者：
Han, Paul K. J.;Klabunde, Carrie N.;Taplin, Stephen H.
背景：针对乳腺癌和宫颈癌筛查存在多种临床实践指南，并且在建议的筛查频率和目标人群方面的积极性有所不同。目的：确定 (1) 美国初级保健医生 (PCP) 对不同临床实践指南影响的看法； （2）有影响力的指南的数量、积极性和一致性与医生筛查建议的积极性之间的关系； (3) 与指南认知相关的因素。 研究设计和方法：2006 年至 2007 年对全国代表性的 1212 名 PCP 进行了调查。横断面分析检查了医生对不同乳腺癌和宫颈癌筛查指南影响的看法、指南看法与针对假设小插曲的筛查建议的关系以及指南看法的预测因素。结果：美国癌症协会和美国妇产科医师学会指南被认为比其他指南更具影响力。大多数医生 (62%) 重视多种指南以及相互冲突和激进的指南组合，而不是保守的指南组合。有影响力的指南的数量、积极性和一致性与筛查建议的积极性相关（P < 0.01）——对于评估多重积极性的医生来说最高，对于评估多重保守性的医生最低，对于评估多重冲突的、单一的和无指南的医生来说中等。产科医生/妇科医生专业预测了积极指南的价值（P < 0.001）。结论：PCP 对癌症筛查指南的看法各不相同，以逻辑一致的方式与筛查建议相关，并且是根据专业和其他因素进行预测的。有价值的指南的数量、积极性和一致性与筛选建议相关，这表明指南的多样性是临床决策中的一个重要问题。
Background: Multiple clinical practice guidelines exist for breast and cervical cancer screening, and differ in aggressiveness with respect to the recommended frequency and target populations for screening.Objectives: To determine (1) US primary care physicians' (PCPs) perceptions of the influence of different clinical practice guidelines; (2) the relationship between the number, aggressiveness, and agreement of influential guidelines and the aggressiveness of physicians' screening recommendations; and (3) factors associated with guideline perceptions.Research Design and Methods: A nationally representative sample of 1212 PCPs was surveyed in 2006-2007. Cross-sectional analyses examined physicians' perceptions of the influence of different breast and cervical cancer screening guidelines, the relationship of guideline perceptions to screening recommendations in response to hypothetical vignettes, and the predictors of guideline perceptions.Results: American Cancer Society and American College of Obstetricians and Gynecologists guidelines were perceived as more influential than other guidelines. Most physicians (62%) valued multiple guidelines, and conflicting and aggressive rather than conservative guideline combinations. The number, aggressiveness, and agreement of influential guidelines were associated with the aggressiveness of screening recommendations (P < 0.01)-which was highest for physicians valuing multiple-aggressive, lowest for physicians valuing multiple-conservative, and intermediate for physicians valuing multiple-conflicting, single, and no guidelines. Obstetrician/gynecologists specialty predicted valuation of aggressive guidelines (P < 0.001).Conclusions: PCPs' perceptions of cancer screening guidelines vary, relate to screening recommendations in logically-consistent ways, and are predicted by specialty and other factors. The number, aggressiveness, and agreement of valued guidelines are associated with screening recommendations, suggesting that guideline multiplicity is an important problem in clinical decision-making.