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背景全科医生在转诊患者进行癌症筛查的决策上面临难题,因为很多癌症症状是由良性自限性疾病造成的。英国国家健康与临床卓越研究所(NICE)转诊指南强调患者应参与决策过程,应被告知转诊原因。然而,目前为止的研究并没有对这些指南的践行程度进行探究。目的探讨患者因癌症相关症状而转诊的决策参与程度,以及患者对转诊的理解。设计与场所进行因肺癌和结直肠癌疑似症状而进行二级医疗转诊患者的定型访谈研究。使用最大变异抽样法,从英格兰两个地区选取患者。方法对访谈记录进行主题分析。结果对34名患者访谈内容进行分析。两种症状的患者均认为转诊决策参与程度低。然而,患者希望进行转诊,从而对不明症状进行解释。此外,分析还发现,转诊的原因通常较为含糊,并不明确为癌症筛查,即使患者症状具有癌症特异性。结论全科医生在癌症疑似症状患者转诊之前,应与患者进行开诚布公的探讨。这将使临床实践与NICE指南接轨,并鼓励全科医生和初级医疗患者对癌症进行更多的坦诚探讨。
Background GPs face challenges in referring patients to cancer screening decisions because many of the cancer symptoms are caused by benign self-limiting diseases. The referral guidelines of the National Institute for Health and Clinical Excellence (NICE) emphasize that patients should be involved in the decision-making process and should be informed of the reasons for referral. However, the research so far has not explored the extent to which these guidelines have been practiced. Objective To explore the extent of decision-making involved in referring patients for cancer-related symptoms and their understanding of referral. Design and Location Stereotypical interviews with patients with secondary medical referrals for suspected lung cancer and colorectal cancer. Patients were selected from two areas in England using the largest variation of sampling method. Methods Subject analysis of interview records. Results The interviews of 34 patients were analyzed. Patients with both symptoms considered the participation decision-making less involved. However, the patient wishes to be referred to explain the unknown symptoms. In addition, the analysis found that the reasons for referral were often vague and not clear for cancer screening, even if the patient’s symptoms were cancer-specific. Conclusion GPs should discuss with patients openly and directly before referring patients with suspected cancer symptoms. This will align clinical practice with NICE guidelines and encourage more thorough discussion of cancer among GPs and primary care practitioners.