Comparing universal Lynch syndrome tumor-screening programs to evaluate associations between implementation strategies and patient follow-through
Comparing universal Lynch syndrome tumor-screening programs to evaluate associations between implementation strategies and patient follow-through
复制标题
比较普遍的林奇综合征肿瘤筛查计划，评估实施策略与患者随访之间的关系
DOI：
10.1038/gim.2014.31
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发表时间：
2014-10-01
影响因子：
8.8
通讯作者：
Pal, Tuya
中科院分区：
文献类型：
--
作者：
Cragun, Deborah;DeBate, Rita D.;Pal, Tuya
目的：对所有结直肠癌患者进行通用肿瘤筛查（UTS）可以提高Lynch综合征的识别率，Lynch综合征是遗传性结直肠癌最常见的原因。这多个案例研究探讨了如何在UTS程序的变化影响患者后续通过（PF）与生殖系检测后，屏幕阳性result.Methods：数据通过基于网络的调查和电话采访机构线人。机构被归类为低PF（40%）。确定实施程序（即，结果：来自15个机构的21名受访者完成了调查和/或访谈。所有五个高PF机构中存在的条件包括：（i）遗传咨询师向患者披露筛查阳性结果;（ii）遗传咨询师促进医生向遗传学专业人员转诊或消除转诊的必要性。虽然这两种高PF条件存在于两个中等PF机构中，但缺乏自动反射测试，难以接触筛查阳性患者是一个障碍。剩下的三个中等PP和五个低PP机构缺乏的条件发现在High-PF institutions.Conclusion：简化UTS程序的方法，纳入高层次的参与遗传咨询师的跟踪和沟通的结果，并在减少障碍，患者接触，审查在更广泛的讨论中，最大限度地提高UTS的有效性和公共卫生的影响。
Purpose: Universal tumor screening (UTS) for all colorectal cancer patients can improve the identification of Lynch syndrome, the most common cause of hereditary colorectal cancer. This multiple-case study explored how variability in UTS procedures influenced patient follow-through (PF) with germ-line testing after a screen-positive result.Methods: Data were obtained through Web-based surveys and telephone interviews with institutional informants. Institutions were categorized as Low-PF (40%). To identify implementation procedures (i.e., conditions) unique to High-PF institutions, qualitative comparative analysis was performed.Results: Twenty-one informants from 15 institutions completed surveys and/or interviews. Conditions present among all five High-PF institutions included the following: (i) disclosure of screen-positive results to patients by genetic counselors; and (ii) genetic counselors either facilitate physician referrals to genetics professionals or eliminate the need for referrals. Although both of these High-PF conditions were present among two Medium-PF institutions, automatic reflex testing was lacking and difficulty contacting screen-positive patients was a barrier. The three remaining Medium-PP and five Low-PP institutions lacked the conditions found in High-PF institutions.Conclusion: Methods for streamlining UTS procedures, incorporating a high level of involvement of genetic counselors in tracking and communication of results and in reducing barriers to patient contact, are reviewed within a broader discussion on maximizing the effectiveness and public health impact of UTS.