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目的探讨各行政辖区的癌症指南和遵守情况是否有所不同,及其对初级医疗卫生(PCPs)对癌症相关症状采取明确措施倾向的影响。设计与场所搜集10个参与国际癌症标杆伙伴组织(International Cancer Benchmarking Partnership)国家(10个行政辖区)的调查数据进行二级分析。方法将PCPs对肺癌(2个)、结直肠癌(2个)与卵巢癌(1个)的5个临床症状的对策与癌症指南中的调查和转诊推荐进行比较。结果 9个国家的指南涉及2个结直肠癌症状。对于癌症症状,8个国家的指南涉及第1个症状,只有瑞典的指南涉及第2个症状。仅有英国和丹麦的指南涉及卵巢癌。对2795例PCPs的调查结果进行分析(调查回复率为12%)。指南遵循的比率为20%~80%。英国的肺癌指南遵循比率低于其他国家(47%和58%,P<0.01),2个结直肠癌指南遵循比率中,一个与其他国家相近(45%和46%),另一个高于其他国家(67%和38%,P<0.01)。当指南推荐不明确或无任何推荐内容时,PCPs最难采取明确措施。与其他国家相比,英国PCPs遵循明确指南建议的情况最差(P<0.01)。各行政辖区指南遵循程度与1年存活率无关联性。结论相似发达国家的癌症指南内容各有差别,指南遵循情况差异无法解释存活率的差异。如果指南未涉及高风险内容或者无明确对策,医生的明确诊断行为会减少。
Objectives To investigate whether there are differences in cancer guidelines and adherence among different jurisdictions and their impact on the tendency of PCPs to take explicit measures on cancer-related symptoms. DESIGN AND SETTINGS A total of 10 survey data from countries participating in the International Cancer Benchmarking Partnership (10 administrative jurisdictions) were collected for secondary analysis. Methods The PCPs responses to five clinical symptoms of lung cancer (2), colorectal cancer (2), and ovarian cancer (1) were compared with those from the cancer guidelines. Results Nine countries’ guidelines involved two colorectal cancer symptoms. For cancer symptoms, the guidelines for the eight countries cover the first symptom, and only the Swedish guidelines refer to the second symptom. Only UK and Denmark guidelines cover ovarian cancer. The survey results of 2795 PCPs were analyzed (survey response rate was 12%). The guidelines follow a ratio of 20% to 80%. British lung ratio is lower than in other countries follow the guide (47% and 58%, P <0.01), 2 knots ratio of colorectal cancer followed guide, one similar to other countries (45% and 46%), other than the other Countries (67% and 38%, P <0.01). It is most difficult for PCPs to take explicit measures when the guidelines are not recommended or recommended. In contrast to other countries, PCPs in the United Kingdom reported the worst recommendations following clear guidelines (P <0.01). There is no correlation between the follow-up of each administrative area guideline and one-year survival rate. Conclusions The contents of cancer guidelines in similar developed countries are different. Differences in guidelines follow conditions can not explain the differences in survival rates. If the guideline does not cover high-risk content or no clear response, the doctor’s definitive diagnosis may decrease.