Abstract:
BACKGROUND:Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older. OBJECTIVE:To understand whether physicians employ individualized decision making for colon cancer screening in older adults, and, if so, to determine the individual factors they believed were important to consider in making such decisions. DESIGN:Qualitative research using focus groups and individual interviews PARTICIPANTS:Fifteen primary care physicians practicing in community settings participated in three focus groups and two interviews. APPROACH:We used two clinical vignettes of 78-year-old women in fair and poor health states to stimulate discussions about clinical decision making for CRC screening in older adults. RESULTS:Physicians considered a wide range of factors, including clinical factors, such as age, life expectancy, co-morbidities, and functional status, as well as individual factors, such as personality, previous screening behavior, family support, and the relationship with the patient. Physicians reported difficulty with these decisions because of their complexity and because they involve life expectancy estimates. Their approach and discussion with patients seemed to be dependent on the degree of certainty they perceived regarding their clinical assessment as to whether the patient had the potential to benefit from screening. CONCLUSIONS:Colorectal cancer screening decision making is complex. Physicians reported using a range of clinical and individual factors to decide about colorectal cancer screening in older adults.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Lewis CL,Griffith J,Pignone MP,Golin Cdoi
10.1007/s11606-009-1006-9subject
Has Abstractpub_date
2009-07-01 00:00:00pages
816-21issue
7eissn
0884-8734issn
1525-1497journal_volume
24pub_type
杂志文章abstract::A prospective study of 79 patients with recent hip fracture revealed prior functional impairments with community mobility (49%), using a bathtub (40%), walking outdoors (26%), and stair-climbing (18%). Eighty-six per cent of patients (mean age 77.9 years) were admitted from home, with 95% surviving to discharge but on...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596300
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:To determine time allocation and the perceived value to education and patient care of the weekday activities of internal medicine housestaff on inpatient rotations and to compare the work activities of interns and residents. DESIGN:An observational study. We classified activities along five dimensions (assoc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00164.x
更新日期:1998-08-01 00:00:00
abstract::Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.012004247.x
更新日期:1997-04-01 00:00:00
abstract:BACKGROUND:Developing a definition of what constitutes high need among Medicare beneficiaries using administrative data is an important prerequisite to evaluating value-based payment reforms. While various definitions of high need exist, their predictive validity for different patient outcomes in the following year has...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4781-3
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms. DESIGN:Prospective longitudinal study involving medical record review and patient survey. SETTING:Ten academically affiliated ambulatory medical practices in the Boston metro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2004.30357.x
更新日期:2004-04-01 00:00:00
abstract::The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a popu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598274
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Residents must master complex skills to care for culturally and linguistically diverse patients. METHODS:As part of an annual 10-station, standardized patient (SP) examination, medical residents interacted with a 50-year-old reserved, Bengali-speaking woman (SP) with a positive fecal occult blood accompanie...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00439.x
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05582-7
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS:Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fis...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0310-5
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:As a result of market forces and maturing technology, generalists are currently providing services, such as colonoscopy, that in the past were deemed the realm of specialists. OBJECTIVE:To determine whether there were differences in patient characteristics, procedure complexity, and clinical indications whe...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.06039.x
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:The 2016 presidential election and the controversial policy agenda of its victor have raised concerns about how the election may have impacted mental health. OBJECTIVE:Assess how mental health changed from before to after the November 2016 election and how trends differed in states that voted for Donald Tru...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06328-6
更新日期:2020-10-31 00:00:00
abstract:BACKGROUND:Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual's obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown. OBJECTIVE:We aimed to estimate the relationship betwee...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3723-1
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To assess the risks and benefits of surgery for herniated lumbar discs (discectomy) and to evaluate the methodologic quality of the literature. DESIGN:Literature synthesis. STUDY SELECTION AND DATA ANALYSIS: A structured MEDLINE search identified studies of standard, microsurgical, or percutaneous discectomy...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,meta分析
doi:10.1007/BF02600110
更新日期:1993-09-01 00:00:00
abstract::The authors surveyed 112 recent alumni and 92 current residents (70% responded) at a residency program that requires original research. Most alumni felt that the research project was a valuable learning experience, particularly in improving their abilities to critically review the medical literature. Almost a third fe...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599759
更新日期:1993-03-01 00:00:00
abstract:OBJECTIVE:To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN:A pre-post comparison of ED u...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:To examine the knowledge of, counseling about, and use of prior directives among patients with HIV-related disease. DESIGN:Cross-sectional survey with personal interviews that was part of the evaluation of a multi-site AIDS Health Services Program. SETTING:Outpatient clinics and AIDS community-based organiz...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600877
更新日期:1990-11-01 00:00:00
abstract::Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient's physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. This is concerning, because more comprehensiv...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3300-z
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) model has several components to improve care for patients with high comorbidity, including greater access to face-to-face primary care. OBJECTIVE:We examined whether high-comorbidity patients had larger increases in primary care provider (PCP) visits attributable to ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3833-9
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4767-1
更新日期:2019-07-01 00:00:00
abstract::Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process pr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3564-3
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Consumers may seek health advice from health food store employees (HFSEs) and pharmacists. Delays in the diagnosis of time-critical illnesses may increase the likelihood of morbidity, mortality and healthcare expenditures. OBJECTIVE:To describe the information provided by HFSEs and pharmacists for symptoms ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1337-6
更新日期:2010-08-01 00:00:00
abstract::General Internal Medicine research evolves in response to the needs of the patients to whom we provide care. Currently, many studies exclude older adults who deeply affect the clinical care of this population. With the number of older adults increasing, creating research protocols that include older adults with multip...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2719-3
更新日期:2014-06-01 00:00:00
abstract:INTRODUCTION:Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. METHODS:We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3053-0
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in prim...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06132-2
更新日期:2020-08-20 00:00:00
abstract::Although intimate partner violence (IPV) remains a major public health problem, physicians often fail to screen female patients. Reported IPV training approaches suffer from weak study designs and limited outcome assessments. We hypothesized that an educational experience for residents at a women's safe shelter would ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-1497.2005.0100.x
更新日期:2005-06-01 00:00:00
abstract:PURPOSE:Recent reports have emphasized the importance of delivery systems in improving health care quality. However, few prior studies have assessed differences in primary care quality between physician groups that differ in size and organizational configuration. We examined whether larger physician group size and affi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0234-0
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients pre...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2137-y
更新日期:2012-12-01 00:00:00
abstract::Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners unde...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0918-8
更新日期:2009-05-01 00:00:00
abstract::This study examined patient acceptance of two different advance directives. Outpatients completed the two directives and a 12-item acceptability questionnaire for each, and then stated their directive preferences. Of 128 patients enrolled, 97 (76%) responded. Overall, 47% of the respondents were satisfied with the Let...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF02599143
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE:To evaluate ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-011-1729-2
更新日期:2011-10-01 00:00:00