Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers.
Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers.
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DOI：
10.1016/j.pmedr.2015.09.003
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发表时间：
2015-01-01
影响因子：
2.8
通讯作者：
Baker, David W
中科院分区：
文献类型：
--
作者：
Brown, Tiffany;Lee, Ji Young;Baker, David W
目的：结直肠癌（CRC）筛查率在一些种族/族裔群体和低收入或低教育程度的个人中仍然较低，他们经常在社区卫生中心（CHC）内接受护理。我们调查了临床医生在网络的CHCs，以了解他们的态度，实践模式，和感知的障碍CRC screening.METHODS：临床医生调查进行了2013年内的社区卫生应用研究网络（CHARN）。参与者平均有11.5年（SD：9.8）的实践经验，62%是女性，57%是医生。大多数受访者多少同意（30.2%）或强烈同意（57.5%）结肠镜检查是最好的筛查试验。然而，只有15.8%的受访者强烈同意，32.2%的受访者同意结肠镜检查对他们的患者来说是现成的。粪便免疫化学检测（FIT），一种类型的粪便潜血试验（FOBT），被视为不太有利; 24.6%的评价FIT作为非常effective.CONCLUSIONS：虽然没有数据显示，筛查结肠镜检查是上级到FIT，CHC临床医生认为结肠镜检查是最好的CRC筛查测试，为他们的病人，尽管高患病率的财政障碍结肠镜检查。这些态度可能是由于缺乏对支持粪便潜血试验（FOBT）长期益处的证据的了解，缺乏对FIT与旧的基于愈创木脂的FOBT相比改进的测试特性的认识，或者缺乏确保遵守定期FOBT筛查的系统。改善CHCs CRC筛查的干预措施必须解决临床医生对FIT的负面态度。
OBJECTIVE: Colorectal cancer (CRC) screening rates remain lower among some racial/ethnic groups and individuals with low income or educational attainment who are often cared for within community health centers (CHCs). We surveyed clinicians in a network of CHCs to understand their attitudes, practice patterns, and perceived barriers to CRC screening.METHODS: A clinician survey was conducted in 2013 within the Community Health Applied Research Network (CHARN).RESULTS: 180 clinicians completed the survey (47.9% response rate). Participants had an average of 11.5 (SD: 9.8) years in practice, 62% were female, and 57% were physicians. The majority of respondents somewhat agreed (30.2%) or strongly agreed (57.5%) that colonoscopy was the best screening test. However, only 15.8% of respondents strongly agreed and 32.2% somewhat agreed that colonoscopy was readily available for their patients. Fecal immunochemical testing (FIT), a type of fecal occult blood test (FOBT), was viewed less favorably; 24.6% rated FIT as very effective.CONCLUSIONS: Although there are no data showing that screening colonoscopy is superior to FIT, CHC clinicians believe colonoscopy is the best CRC screening test for their patients, despite the high prevalence of financial barriers to colonoscopy. These attitudes could be due to lack of knowledge about the evidence supporting long-term benefits of fecal occult blood testing (FOBT), lack of awareness about the improved test characteristics of FIT compared to older guaiac-based FOBT, or the absence of systems to ensure adherence to regular FOBT screening. Interventions to improve CRC screening at CHCs must address clinicians' negative attitudes towards FIT.