Lung cancer screening: Practice guidelines and insurance coverage are not enough.
Lung cancer screening: Practice guidelines and insurance coverage are not enough.
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肺癌筛查：实践指南和保险范围还不够。
DOI：
10.1097/jxx.0000000000000096
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发表时间：
2019
影响因子：
1.2
通讯作者：
Eberth,JanM
中科院分区：
文献类型：
--
作者：
McDonnell,KarenKane;Estrada,RobinDawson;Dievendorf,AmyClark;Blew,Lauren;Sercy,Erica;Khan,Samira;Hardin,JamesW;Warden,Deborah;Eberth,JanM
背景和目的：低剂量计算机断层扫描（LDCT）有望提高肺癌的早期发现率和改善生存率。在初级保健设置的高级执业护士（NP）的数量的增长增加的可能性，NP将作为患者的提供者。本研究的目的是检查知识，态度和做法，关于LDCT在NP谁在初级保健settings.Methods工作：一个解释性的，顺序的，混合的方法设计使用了32项问卷，其次是半结构化的电话采访。发展的调查和访谈问题的指导下，一个概念框架，代表一个时间序列的行为变化和潜在的障碍，以指导adherence.Conclusions：执业护士认为，共同决策与他们的高风险患者LDCT是在他们的范围内，他们的做法。在时间有限的初级保健环境中工作，NP提高LDCT摄取的能力有限。存在着大量的患者障碍，阻碍了对提供者建议的贯彻执行。传播指南和授权健康保险报销是不够的。对实践的影响：需要研究，调查筛选过程，以便可以密切研究的障碍。在早期发现对保险公司、提供者和患者有更大价值的地方，需要改变文化。
Background and purpose:Low-dose computed tomography (LDCT) is expected to increase early detection of lung cancer and improve survival. The growth in the number of advanced nurse practitioners (NPs) in primary care settings increases the likelihood that an NP will serve as a patient’s provider. This study's purpose was to examine knowledge, attitudes, and practices regarding LDCT among NPs who work in primary care settings.Methods:An explanatory, sequential, mixed-method design used a 32-item questionnaire, followed by a semi-structured telephone interview. The development of the survey and interview questions were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence.Conclusions:Nurse practitioners believe that shared decision making with their high-risk patients about LDCT is within their scope of their practice. Working in time-constrained primary care settings, NPs have limited abilities to improve the uptake of LDCT. Substantial patient barriers exist that deter follow through on providers' recommendation. Disseminating guidelines and authorizing health insurance reimbursement is insufficient.Implications for practice:Research is needed that investigates the screening process so that barriers can be closely studied. Culture change is needed where early detection has greater value for insurers, providers, and patients.