Family physician beliefs about cancer screening. Development of a survey instrument

To improve rates at which physicians provide cancer control procedures, it is first necessary to identify physician and environmental characteristics that explain variations in those rates. This study used an attitude-behavior model as a guiding framework to identify beliefs, sources of influence, facilitating conditions, and critical events that may be important determinants of physicians' rates for providing eight cancer control activities. Open-ended, semistructured interviews were conducted with 26 family physicians to discuss the factors that may have affected their policies for providing each of the eight cancer control activities. Content analysis of those interviews produced unique lists of beliefs, sources of influence, facilitating conditions, and critical events for each activity. These lists of factors are more comprehensive than those identified in previous studies. A questionnaire has been developed based on these findings, and a validation study is being conducted to identify the factors that best explain variation in rates at which cancer control activities are performed.     

Preventive surgical prcedures for inherited risk of breast cancer

Preventive surgical procedures for inherited risk of breast cancer Forwomen with a demonstrated BRCA1 or BRCA2 mutation, the cumulative risk of developing invasive breast cancer before the age of 70 years is about 50-85% and the risk of developing invasive epithelial ovarian cancer is 20-60%. Regular surveillance including physical examination and imaging is offered to mutation carriers and the options for risk-reducing surgery are discussed. Although bilateral prophylactic mastectomy is a drastic intervention, it significantly reduces the incidence of breast cancer. For mutation carriers with breast cancer, the decision to combine risk-reducing surgery with treatment is determined by the TNM stage of the disease. Prophylactic bi- or contralateral mastectomy after previous treatment for unilateral breast cancer reduces the incidence of contralateral breast cancer, but has no impact on survival. The complexity of the problem demands a multidisciplinary approach within the context of a family cancer clinic.     

Family physician consultation patterns indicate high risk for early-onset anorexia nervosa

OBJECTIVE: There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. METHOD: Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group comprising 19 girls with anorexia nervosa, onset under 14; (b) a clinical control group comprising 19 girls with an emotional disorder; and (c) a nonclinical group comprising 19 girls with no history of mental health problems. RESULTS: Both clinical groups had an elevated number of consultations, particularly in the 5 years before diagnosis. The index group had a significantly higher number of eating, weight, and shape consultations (especially in the year before diagnosis), whereas the clinical control group had a greater number of psychological consultations. CONCLUSION: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.     

Family physicians'' knowledge of risk factors for cervical cancer

A woman's risk for cervical cancer has been used by physicians to guide the initiation and frequency of a Pap smear. The aim of this study was to determine family physicians' knowledge of risk factors for cervical cancer and perceived importance of risk in screening women.     

Family therapy techniques for the family physician

Since 1960, family therapy has emerged from the general field of psychotherapy as a discipline in itself. An extensive literature has been developed, much of it based on general systems theory. Family physicians have routinely recognized problem families within their practice. Skills and techniques are suggested in this article for introducing changes within a family system.     

Assessing perceived benefits/barriers and self-efficacy for cervical cancer screening among Korean American women

A large proportion of Korean American women (KAW) do not receive regular cervical cancer screening. Self-report data from 102 KAW were analyzed by multiple linear regressions. As compared to women in action/maintenance, women in precontemplation/relapse stages were less likely to agree that a Pap test is important for health and were more likely to endorse barriers to testing (cost, not having a female doctor, preference for Korean medicine). Women in precontemplation/relapse stages also reported lower scores on self-efficacy items (travel large distances, pain perceptions, financial costs, and time). Differences in specific aspects may be informative for interventions to improve screening rates among KAW.     

The role of physician reminders in faecal occult blood testing for colorectal cancer screening

Objective: To evaluate the ability of elbow extension, with the patient in a supine position, as a diagnostic test of an insignificant injury, with the purpose of avoiding unnecessary radiographs. Methods: Seventy patients suffering from an acute elbow injury were examined at the accident and emergency department. Inability to fully actively extend the elbow in a supine position was defined as a positive diagnostic test. Radiographs were interpreted by a consultant radiologist, blinded to all clinical examination results. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios along with their 95% confidence intervals were calculated for the elbow-extension test. Results: Forty out of 70 patients had a positive test. Elbow fracture or dislocation was identified radiographically in 22 patients with positive test (sensitivity 92%). Two out of 30 (with negative test) had a hairline radial head fracture, which was found on radiographs (specificity 61%). Conclusion: Elbow extension as a diagnostic test in a primary care setting can predict severe elbow injuries and can be safely used in practices with no radiology facilities.     

Colorectal cancer screening: physician recommendation is influential advice to Marylanders

BACKGROUND: In comparison to the United States, Maryland is facing a significantly higher burden of colorectal cancer incidence and mortality. The primary objective of this study was to determine the predictors of colorectal cancer screening use in Maryland. METHODS: We performed secondary analyses on Maryland Cancer Survey 2002 data from 2994 respondents to investigate important predictors for individual colorectal cancer screening tests. CRC screening outcomes were defined as (1) FOBT within the past year, (2) sigmoidoscopy within the past 5 years, or (3) colonoscopy within the past 10 years. RESULTS: We found that clinician recommendation for a screening test is the best predictor in both age categories (50-64 years and 65+ years); it is a very strong indicator and consistently improves the odds of use by a factor of at least 8 for any screening test. CONCLUSIONS: There remains a great need for improved colorectal cancer screening in Maryland. According to our results, it is clear that the most influential way to improve overall colorectal cancer screening for each test and both age groups is to increase clinician recommendation for these tests.     

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer

PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer.METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care.RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care.CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up.     

Factors associated with colon cancer screening: the role of patient factors and physician counseling

BACKGROUND: The prevalence of colon cancer screening is nationally low. The relative contribution of patient factors and physician counseling patterns to the low prevalence of screening is unclear. METHODS: We used multivariable analysis to examine the prevalence of colon cancer screening nationally and the reasons for this low prevalence using data from the 2000 National Health Interview Survey, a nationally generalizable survey of US households. RESULTS: Among 11,427 respondents to the Cancer Control Supplement, 16% reported annual fecal occult blood testing (FOBT) and 29% reported having undergone a sigmoidoscopy in the last 5 years or a colonoscopy in the last 10 years. After adjusting for age, sex, body mass index (BMI), healthcare access, and region of the country, Hispanics were less likely to undergo FOBT [OR 0.7 (95% CI 0.6-0.9)] and sigmoidoscopy or colonoscopy [OR 0.8 (95% CI 0.7-0.9)] compared to Whites. Respondents with lower education levels were also less likely to undergo screening. These factors were not associated with being less adherent to physician recommendations for screening. Nevertheless, non-Whites and those less educated were less likely to receive counseling from their health provider about colon cancer screening. Among respondents who did not undergo FOBT, 64% were unaware they needed the test; only 2% cited pain and discomfort as a deterrent, but 94% were not counseled by their physician about the test. Among those who did not undergo sigmoidoscopy or colonoscopy, 72% were unaware that they needed the test and only 1% was deterred by pain and discomfort; 92% were not counseled by their physician. CONCLUSION: The low prevalence of screening for colorectal cancer appears to be due to lack of awareness and inadequate provider counseling rather than poor patient acceptance for screening. Systematic counseling about colorectal cancer screening will likely improve screening rates and reduce disparities by race/ethnicity and education.     

Family physicians' beliefs about breast cancer screening by mammography

A survey of 509 family physicians in New York State was conducted to assess opinions about mammography and use of mammography in screening asymptomatic women of different ages. Findings indicate that most family physicians believe that mammography is an effective procedure for detecting breast cancer in its early stages, but many do not utilize mammography as a screening procedure in their own practices. The major deterrents to the use of mammography in screening asymptomatic women relate to concerns about the safety and reliability of the procedure, the low probability of detecting breast cancer through screening, the patient's willingness to accept a recommendation to have a mammogram, and cost. The results from this study point out the need to better educate primary care physicians about the use of mammography in screening for breast cancer, especially in regard to its safety and reliability.     

高危型人乳头状瘤病毒DNA检测在宫颈癌筛查中的应用

目的通过对临床资料观察研究,探讨高危型人乳头状瘤病毒(humanpapillomavirus,HPV)DNA检测在子宫颈癌筛查程序中的应用效能。方法选择2003年6~12月在本院宫颈门诊就诊的18~60岁、宫颈细胞学检查(液基细胞检查方法)结果为非典型鳞状上皮细胞(ASCUS)或低度鳞状上皮内病变(LSIL)的病例,采用Digene基因杂交捕获法(HC2)检测高危型HPVDNA,同时进行阴道镜活组织检查。结果共对335例病例进行高危型HPVDNA检测,阳性率为62.09%;其中<30岁年龄组阳性率(79.04%)高于≥30岁年龄组(45.24%)(P<0.01)。阴道镜活组织检查,中重度宫颈上皮内瘤样病变(CIN2或CIN3)阳性率为35.22%(118/335),其中<30岁年龄组阳性率(43.11%)高于≥30岁年龄组(27.38%)(P<0.01)。高危型HPVDNA检测诊断CIN2/CIN3的灵敏度为93%,特异性为55%,阳性预测值为53%,阴性预测值为94%。结论在宫颈细胞学涂片检查结果为ASCUS/LSIL的病例中,高危型HPV感染作为CIN2/CIN3的标志物是可靠的,高危型HPVDNA检测是子宫颈癌筛查的有效手段。     

Patterns of breast cancer screening among lesbians at increased risk for breast cancer

BACKGROUND: Women with a family history of breast cancer (i.e., in a mother, sister or daughter) are at increased risk for this disease. Previous data also suggest that lesbians are at increased risk for breast cancer. While the screening behaviors of women with a family history have been described, little is known about factors that influence screening behaviors of lesbians with the same risk factor profile. PURPOSE: The purpose of this study was to characterize the perceptions of susceptibility to breast cancer and describe factors that influence adherence to breast cancer screening guidelines in a sample of lesbians with a first-degree relative with a diagnosis of breast cancer. METHODS: Structured telephone interviews were conducted on a sample of 139 self-identified lesbians who had a first-degree relative with a diagnosis of breast cancer, were between the ages of 35 to 75 and had no previous history of cancer. Cross-sectional data obtained, included socio-demographics, breast cancer risk factors, breast cancer screening patterns, breast cancer perceptions, worries, and knowledge, and barriers and access to health care factors. Individual subject characteristics were examined for their association with adherence to mammography guidelines followed by a multivariate analysis to evaluate the most important combinations of factors. Outcome measures were age-specific adherence to ACS guidelines for both mammography and overall adherence (i.e., mammography, clinical breast examination and breast self-examination). RESULTS: The 139 lesbians interviewed for this study were young (mean age = 43), almost exclusively white (94%), highly educated (78% = college graduate and beyond), and partnered (68%). In the bivariate analysis of individual factors, being employed and reporting breast cancer worries were significantly and positively associated with adherence to mammography guidelines. Higher income and insurance type were significantly associated with mammography adherence. No factors were significantly associated with overall adherence. Multivariate logistic regression analyses revealed that only income level and degree of breast cancer worries were significantly and positively associated with mammography adherence. However, since there was a high correlation between income level and employment status, a regression model with employment status and worry was also significantly related to mammography adherence. CONCLUSIONS: In lesbians who are at an increased risk for breast cancer because of family history, breast cancer worries may motivate, rather than deter, adherence for mammography use. High income levels also appear to enable adherence in this population. IMPLICATIONS: Additional studies are needed to validate these findings, identify the prevalence of lesbians in general samples of women at increased risk for breast cancer, and prospectively test lesbian sensitive educational intervention strategies designed to facilitate adherence to mammography screening guidelines in this population.     

The impact of referral to a primary physician on cervical cancer screening

OBJECTIVES: The purpose of this study was to determine whether referral to a primary physician led to an increase in screening for cervical cancer among women enrolled in Delaware Medicaid. METHODS: Medicaid claims data were used to compare annual Papanicolaou (Pap) test rates for women referred to a primary care physician or obstetrician (n = 365) with rates for age-matched comparison women who were not referred (n = 1799). RESULTS: Thirty-eight percent of referred women and 27% of comparison women underwent Pap tests (adjusted odds ratio = 1.71; 95% confidence interval = 1.33, 2.20). CONCLUSIONS: Referral to a primary physician had a positive impact on cervical cancer screening among the study participants.     

Primary care physician smoking screening and counseling for patients with chronic disease

BackgroundEvidence-based guidelines recommend smoking cessation treatment, including screening and counseling, for all smokers, including those with chronic diseases exacerbated by smoking. Physician treatment improves smoking cessation. Little data describes smoking treatment guideline uptake for patients with chronic cardiopulmonary smoking-sensitive diseases.ObjectiveDescribe U.S. primary care physician (PCP) smoking cessation treatment during patient visits for chronic cardiopulmonary smoking-sensitive diseases.MethodsThe National (Hospital) Ambulatory Medical Care Survey captured PCP visits. We examined smoking screening and counseling time trends for smokers with chronic diseases. Multivariable logistic regression assessed factors associated with smoking counseling for smokers with chronic smoking-sensitive diseases.ResultsFrom 2001–2009 smoking screening and counseling for smokers with chronic smoking-sensitive cardiopulmonary diseases were unchanged. Among smokers with chronic smoking-sensitive diseases, 50%–72% received no counseling. Smokers with chronic obstructive pulmonary disease (COPD) (odds ratio (OR) = 6.54, 95% confidence interval (CI) 4.85–8.83) and peripheral vascular disease (OR = 4.50, 95% CI 1.72–11.75) were more likely to receive smoking counseling at chronic/preventive care visits, compared with patients without smoking-sensitive diseases. Other factors associated with increased smoking counseling included non-private insurance, preventive and longer visits, and an established PCP. Asthma and cardiovascular disease showed no association with counseling.ConclusionsSmoking cessation counseling remains infrequent for smokers with chronic smoking-sensitive cardiopulmonary diseases. New strategies are needed to encourage smoking cessation counseling.