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Lutaud R, Ollivier Q, Fierling T. Shared medical decision in prostate cancer screening in primary care: a systematic literature review of current evidence. Int Urol Nephrol 2024; 56:2251-2259. [PMID: 38316684 DOI: 10.1007/s11255-024-03947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/31/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Prostate cancer screening has not significantly reduced mortality. International guidelines strongly endorse shared decision-making to navigate risks, emphasizing its crucial role prior to prescribing a prostate-specific antigen test. This study aims to provide insight into the current role of shared decision-making in primary care for prostate cancer screening and suggest ways to improve the process. METHODS PubMed, Cochrane, and Lissa databases were searched for following terms: 'prostate-specific antigen' or 'prostate cancer screening' combined with 'shared decision making', 'informed decision making' or 'decision support' and 'primary care'. All studies were screened by two independent reviewers. This systematic review followed the PRISMA guidelines. RESULTS Of 85 articles screened, 34 were included. Key findings included heterogenous and poor quality implementation of shared decision-making in practice, patients with limited knowledge of shared decision-making, clinicians infrequently discussing patients' views, decision aids that could be better integrated into practice, and finally, changes in care systems to support the expansion of shared decision-making in prostate cancer screening. CONCLUSION Decision aids are essential tools in the informed decision-making process. Integrating these elements into practice would require training for doctors and adjustments to the healthcare system.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix-Marseille University, 27 Bd Jean Moulin, 13385, Marseilles, France.
- Aix-Marseille University, CNRS, EFS, ADES, Marseilles, France.
| | - Quentin Ollivier
- Department of General Practice, Aix-Marseille University, 27 Bd Jean Moulin, 13385, Marseilles, France
| | - Thomas Fierling
- Department of General Practice, Aix-Marseille University, 27 Bd Jean Moulin, 13385, Marseilles, France
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2
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Barqawi HJ, Samara KA, Haddad ES, Bakkour LM, Amawi FB. Attitudes and practices to adult vaccination among physicians before and after COVID-19 pandemic in the United Arab Emirates. Vaccine X 2024; 17:100455. [PMID: 38356876 PMCID: PMC10865396 DOI: 10.1016/j.jvacx.2024.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Vaccination remains underutilised worldwide with low vaccine uptake rates across the board with many adults remaining unprotected. Across the Arab world, attitudes towards vaccines vary but high rates of vaccine hesitancy have been found. This study aims to explore the adult vaccination attitudes and practices by physicians in the UAE, both before and after the introduction of the COVID-19 vaccines. Methodology This cross-sectional, descriptive study used convenience and snowball sampling to collect comprehensive data from UAE physicians. A self-administered questionnaire was distributed in two stages: the first (pre-COVID-19 vaccines) between the months of June and October 2020 and the second between the months of November 2022 and March 2023. Results 1000 responses, 500 from each time period, were collected. Nearly a third were family physicians or internists with more than 70% of the physicians working in governmental hospitals. 95% agreed that vaccines are safe in both cohorts but 74.4% reported not having enough time to advise about vaccines. 80.8% of physicians in the 2022 cohort reported safety concerns as the most common reason for patients to refuse vaccines. The most recommended vaccines were influenza (68.6%), Hepatitis B (66.0%) and HPV (61.4%), with pneumococcal coming in close at 57.8%. Family medicine physicians showed the highest utilisation of preventive practices across both cohorts. Nearly half of all family medicine physicians did not regularly evaluate both the influenza and general immunisation status of their patients. 54.6% of physicians reported having patients with VPDs in the last five years (not including COVID-19) in 2022. Conclusion Physicians have overly positive attitudes, but their practices reflect a more superficial appreciation of vaccines and lack of initiative. Physicians need to adopt a pro-vaccine stance, armed with the proper tools and the right mentality and beliefs.
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Affiliation(s)
- Hiba J. Barqawi
- Department of Clinical Sciences, College of Medicine, University of Sharjah, United Arab Emirates
| | - Kamel A. Samara
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Enad S. Haddad
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Layane M. Bakkour
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Firas B. Amawi
- Dr. Sulaiman Al Habib Hospital, Dubai, United Arab Emirates
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3
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Richard A, Trefond J, Lambert C, Balandreaud G, Vaillant-Roussel H. Patients' acceptance of less blood pressure measurement in consultation: a cross-sectional study in general practice. Fam Pract 2023; 40:55-60. [PMID: 35642891 DOI: 10.1093/fampra/cmac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Blood pressure (BP) is measured at almost every general practitioner (GP) consultation in the region of Auvergne, France. A 2018 qualitative study shows that GPs measure BP to satisfy patients, whereas patients declare themselves indifferent to the absence of the measurement. The objective was to validate the results of a qualitative study, to quantitatively assess patient satisfaction when BP is not measured, and to study the factors associated with the degree of patient satisfaction. METHODS This was a quantitative observational study conducted using self-questionnaires among patients in medical practices in Auvergne. RESULTS Four hundred and ninety-two questionnaires were evaluated in 20 medical practices. Sixty percent of patients had indifferent or favorable feelings in the absence of BP measurement. In bivariate analysis, young age, male sex, absence of pathology, and low frequency of visits were associated with indifferent or favorable feelings in the absence of BP measurement. In multivariable analysis, a history of hypertension and psychiatric history were associated with unfavorable feelings. The intraclass correlation coefficient for practice-related variability was 5.6%. Patients' susceptibility to having particularly favorable or unfavorable feelings could be related to their GP (physician effect). CONCLUSION The hypothesis put forward in the qualitative study is confirmed: the majority of patients are in favor of or indifferent to the absence of BP measurement in general practice. General practice could be more efficient by measuring BP less frequently and better.
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Affiliation(s)
- Amélie Richard
- Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France.,Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France.,Maison de Santé Pluriprofessionnelle des Batignolles (MSP), Joze, France
| | - Jeromine Trefond
- Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France.,Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Balandreaud
- Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France
| | - Hélène Vaillant-Roussel
- Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France.,Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France.,DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
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4
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Curran RL, Kukhareva PV, Taft T, Weir CR, Reese TJ, Nanjo C, Rodriguez-Loya S, Martin DK, Warner PB, Shields DE, Flynn MC, Boltax JP, Kawamoto K. Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing. J Am Med Inform Assoc 2021; 27:1225-1234. [PMID: 32719880 DOI: 10.1093/jamia/ocaa099] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. MATERIALS AND METHODS We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. RESULTS With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants' mental models of disease and for intuitive navigation in order to decrease cognitive load. DISCUSSION Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. CONCLUSIONS Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.
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Affiliation(s)
- Rebecca L Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | | | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- Community Physicians Group, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Boltax
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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McFadden T, Fortier M, McGinn R, Levac BM, Sweet SN, Tomasone JR. Demographic differences in Canadian medical students' motivation and confidence to promote physical activity. Fam Pract 2020; 37:56-62. [PMID: 31271643 DOI: 10.1093/fampra/cmz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity (PA) remains under prescribed by physicians. Motivation and confidence are clear drivers of frequency of promoting PA. Research shows demographic differences in physicians' preventive practices, yet none have included medical students who form habits during training. OBJECTIVES Study objectives were to (i) examine how Canadian medical students' motivation to recommend PA to future patients differs according to six demographic variables (i.e. gender, ethnicity, year of study, university, proposed specialty and academic background) and (ii) examine how Canadian medical students' confidence to recommend PA to future patients differs according to these same demographic variables. METHODS A cross-sectional design was used. First to fourth year medical students from three medical schools responded to an online survey (N = 221). RESULTS Female participants were more motivated to counsel patients on PA and refer to an exercise specialist compared to males (P < 0.01). Second year students were more motivated to assess a patients' level of PA compared to third and fourth year students (P < 0.01). Students pursuing family medicine were more confident to assess and counsel compared to students pursuing paediatrics (P < 0.01). CONCLUSION Given that motivation and confidence have a positive influence on frequency-promoting PA, these results suggest where future efforts should focus, to improve PA promotion in medical practice. Physical inactivity continues to be a major issue worldwide, and medical students as future physicians have a unique opportunity to enhance PA amongst the population.
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Affiliation(s)
- Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa.,Physician Health and Wellness, Canadian Medical Association, Ottawa
| | | | - Ryan McGinn
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa.,Faculty of Medicine, University of Ottawa, Ottawa
| | - Brendan M Levac
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
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Rosário F, Vasiljevic M, Pas L, Fitzgerald N, Ribeiro C. Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial. Fam Pract 2019; 36:199-205. [PMID: 29939239 DOI: 10.1093/fampra/cmy062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. OBJECTIVE To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. METHODS We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. CONCLUSION This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. TRIAL REGISTRATION clinicaltrials.gov NCT02968186.
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Affiliation(s)
- Frederico Rosário
- Tomaz Ribeiro Primary Health Care Center, Dão Lafões Primary Health Care Centers Grouping, Viseu, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Milica Vasiljevic
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Division of Quality Management, Directorate-General of Health, Lisbon, Portugal
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Costa M, Yaya I, Mora M, Marcellin F, Villotitch A, Berenger C, Tanti M, Cutarella C, Polomeni P, Maradan G, Roux P, Rolland B, Carrieri PM. Barriers and levers in screening and care for alcohol use disorders among French general practitioners: results from a computer-assisted telephone interview-based survey. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1514989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marie Costa
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Issifou Yaya
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Antoine Villotitch
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cyril Berenger
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marc Tanti
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | | | | | - Gwenaelle Maradan
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Institut national de la santé et de la recherche médical U1028, Centre national de la recherche scientifique UMR5292, Univ Lyon, Université Claude Bernard Lyon 1, France
| | - Patrizia Maria Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
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Selby K, Bartlett-Esquilant G, Cornuz J. Personalized cancer screening: helping primary care rise to the challenge. Public Health Rev 2018; 39:4. [PMID: 29484218 PMCID: PMC5820801 DOI: 10.1186/s40985-018-0083-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/19/2018] [Indexed: 12/18/2022] Open
Abstract
With their longitudinal patient relationships, primary care physicians and their care teams are uniquely situated to promote preventive medicine, including cancer screening. A confluence of forces is driving the demand for the personalization of cancer screening recommendations. Recommendations are increasingly based on individual patient preferences, medical history, genetic and environmental risk factors, and level of interaction with the healthcare system. Current examples include choices between colonoscopy, fecal testing, and emerging tests for colorectal cancer (CRC) screening; the use of genetic information and availability of home self-testing in cervical cancer screening; the integration of multiple risk factors and patient preferences to decide the intensity and length of breast cancer screening; and the issues of smoking cessation and competing priorities when deciding whether or not to pursue lung cancer screening. These changes will inevitably increase the burden on primary care of providing high-quality cancer screening to their patients. To address, primary care physicians need access to continuously updated evidence reviews including prioritization of strongly supported recommendations, training in shared decision-making and tools for preference diagnosis, and an electronic health record (EHR) and reimbursement model that allow for population health management and team-based care. Only by reinforcing cancer screening in primary care can we ensure that personalized cancer screening is accessible and evidence-based.
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Affiliation(s)
- Kevin Selby
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Gillian Bartlett-Esquilant
- Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, Quebec H3S 1Z1 Canada
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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