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首页> 外文期刊>BMC Family Practice >Could it be colorectal cancer? General practitioners’ use of the faecal occult blood test and decision making – a qualitative study
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Could it be colorectal cancer? General practitioners’ use of the faecal occult blood test and decision making – a qualitative study

机译：可能是大肠癌吗？全科医生对粪便隐血测试和决策的使用-定性研究

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Background Abdominal complaints are common reasons for contacting primary care physicians, and it can be challenging for general practitioners (GPs) to identify patients with suspected colorectal cancer (CRC) for referral to secondary care. The immunochemical faecal occult blood test (iFOBT) is used as a diagnostic aid in primary care, but it is unclear how test results are interpreted. Studies show that negative tests are associated with a risk of delayed diagnosis of CRC and that some patients with positive tests are not investigated further. The aim of this study was to explore what makes GPs suspect CRC and to investigate their practices regarding investigation and referral, with special attention on the use of iFOBTs. Method Semi-structured individual interviews were conducted with eleven purposely selected GPs and registrars in Region J?mtland H?rjedalen, Sweden, and subjected to qualitative content analysis. Results In the analysis of the interviews four categories were identified that described what made the physicians suspect CRC and their practices. Careful listening—with awareness of the pitfalls: Attentive listening was described as essential, but there was a risk of being misled by, for example, the patient’s own explanations. Tests can help—the iFOBT can also complicate the diagnosis: All physicians used iFOBTs to various extents. In the absence of guidelines, all found their own ways to interpret and act on the test results. To refer or not to refer—safety margins are necessary: Uncertainty was described as a part of everyday work and was handled in different ways. Common vague symptoms could be CRC and thus justified referral with safety margins. Growing more confident—but also more humble: With increasing experience, the GPs described becoming more confident in their decisions but they were also more cautious. Conclusions Listening carefully to the patient’s history was essential. The iFOBT was frequently used as support, but there were considerable variations in the interpretation and handling of the results. The diagnostic process can be described as navigating uncertain waters with safety margins, while striving to keep the patient’s best interests in mind. The iFOBT may be useful as a diagnostic aid in primary care, but more research and evidence-based guidelines are needed.
机译：背景技术腹部不适是联系初级保健医生的常见原因，对于全科医生（GPs）而言，要鉴定患有疑似结直肠癌（CRC）的患者以转诊至二级保健可能具有挑战性。免疫化学粪便潜血测试（iFOBT）在初级保健中被用作诊断辅助手段，但尚不清楚如何解释测试结果。研究表明，阴性测试与CRC延迟诊断的风险有关，并且一些阳性测试的患者无需进一步研究。这项研究的目的是探索使全科医生怀疑CRC的原因，并调查他们在调查和转诊方面的做法，并特别注意使用iFOBT。方法在瑞典的Jmtmtland H？rjedalen地区，对11个经过精心挑选的GP和注册服务商进行了半结构化的个人访谈，并进行了定性内容分析。结果在对访谈进行的分析中，确定了四个类别，这些类别描述了导致医师怀疑CRC及其行为的原因。仔细聆听-意识到陷阱：认真聆听被描述为必不可少的，但是存在被例如患者自己的解释所误导的风险。测试可以帮助您-iFOBT还可使诊断复杂化：所有医生都在不同程度上使用了iFOBT。在没有指导原则的情况下，所有人都找到了自己的方式来解释测试结果并根据测试结果采取行动。引用或不引用-安全裕度是必要的：不确定性被描述为日常工作的一部分，并且以不同的方式处理。常见的模糊症状可能是CRC，因此有理由转诊时要考虑安全性。变得更加自信，但也变得更加谦虚：随着经验的增长，GP表示对自己的决定变得更加自信，但他们也更加谨慎。结论认真倾听患者的病史至关重要。 iFOBT通常用作支持，但是结果的解释和处理存在很大差异。诊断过程可以描述为在安全范围内导航不确定的水域，同时努力牢记患者的最大利益。 iFOBT可用作初级保健的诊断辅助工具，但还需要更多的研究和循证指南。

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