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Provider ordering and patient refusal of colorectal cancer screening.

机译：提供者订购和患者拒绝大肠癌筛查。

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摘要

Background. Mass screening for colorectal cancer (CRC) and removal of precursor lesions dramatically reduces both incidence and mortality from CRC. Most of the eligible population has not been screened. Disparity of screening exists within populations across the domains of race/ethnicity, gender and age. Objective. To describe the patients eligible for colorectal cancer screening and the practice of provider ordering and patient refusal of colorectal cancer screening in one Veteran's Affairs Healthcare setting (VA). Design. Descriptive cross sectional study utilizing a secondary analysis of data from the VA electronic medical record system, Veterans Health Information Systems & Technology Architecture (VISTA). Participants. 4,315 men and women aged 50 years and older eligible for CRC screening between August 2004 and January 2005 at the San Francisco VA Medical Center and its Community Based Outpatient Clinics, CBOCs. Measurements. Independent variables were the demographic characteristics age, gender and race. Dependent variables were provider screening order, type of screening (FOBT, sigmoidoscopy, or colonoscopy), provider decision screening not indicated and patient refusal of screening. Results. Overall 1,751 (38.9%) of those eligible had screening ordered. Of the remaining eligible patients 1,311 (29.2%) refused screening and 1,433 (31.9%) had no screening ordered due to a provider determining it was not indicated. CRC screening rate was equivalent for men and women. For every 10 years younger a patient was 1.62 times more likely to be screened (95% CI 1.529 P 1.727). Race was associated with patient decision not to be screened (chi 2 14.97, df1, p .001) and with provider decision to order colonoscopy vs. other screening methodologies (chi2 32.43, df8, p .000). Conclusions. Providers determined that screening was not indicated primarily due to patient chronic health problems. This finding raises questions and supports re-evaluation of the appropriateness of the VA CRC screening program and performance measures. A significant number of patients refused provider recommendations for screening. The reasons for patient refusal are unclear. Young black men refused more than any other group. This knowledge could support interventions to improve better communication and education regarding the risks and benefits of screening.
机译：背景。结直肠癌（CRC）的大规模筛查和前体病变的清除大大降低了CRC的发病率和死亡率。尚未筛选大多数合格人群。跨种族/族裔，性别和年龄的人群中存在筛查差异。目的。描述在一种退伍军人事务医疗机构（VA）中符合资格接受大肠癌筛查的患者以及提供者订购和拒绝大肠癌筛查的实践。设计。描述性横断面研究利用VA电子病历系统（退伍军人健康信息系统和技术架构（VISTA））的数据进行了二次分析。参加者在2004年8月至2005年1月期间，有4315名年龄在50岁以上的男女在旧金山弗吉尼亚州医疗中心及其社区门诊诊所进行了CRC筛查。测量。自变量是年龄，性别和种族的人口统计学特征。因变量包括提供者筛查顺序，筛查类型（FOBT，乙状结肠镜或结肠镜检查），未显示提供者决策筛查和患者拒绝筛查。结果。总计1,751（38.9％）位符合条件的人被要求进行筛查。在剩余的合格患者中，有1,311名（29.2％）拒绝筛查，有1,433名（31.9％）拒绝筛查，原因是提供者确定未进行筛查。 CRC筛查率与男性和女性相当。每10岁以下的患者接受筛查的可能性就高1.62倍（95％CI 1.529

著录项

  • 作者

    Baird, Polly A.;

  • 作者单位

    University of California, San Francisco.;

  • 授予单位 University of California, San Francisco.;
  • 学科 Health Sciences Nursing.; Health Sciences Medicine and Surgery.; Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2006
  • 页码 80 p.
  • 总页数 80
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;预防医学、卫生学;
  • 关键词

  • 入库时间 2022-08-17 11:40:12

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