J. Med. Internet Res. - Supporting patients treated for prostate cancer: a video vignette study with an email-based educational program in general practice.

Tópicos

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Resumo

CKGROUND: Men who have been treated for prostate cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following treatment. However, there is no evidence that such men are consistently advised by GPs and patients experience substantial unmet need for reassurance and advice.OBJECTIVE: The intent of the study was to evaluate a brief, email-based educational program for GPs to manage standardized patients presenting with symptoms or side effects months or years after prostate cancer treatment.METHODS: GPs viewed six pairs of video vignettes of actor-patients depicting men who had been treated for prostate cancer. The actor-patients presented problems that were attributable to the treatment of cancer. In Phase 1, GPs indicated their diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis. These responses were compared to the management decisions for those vignettes as recommended by a team of experts in prostate cancer. After Phase 1, all the GPs were invited to participate in an email-based education program (Spaced Education) focused on prostate cancer. Participants received feedback and could compare their progress and their performance with other participants in the study. In Phase 2, all GPs, regardless of whether they had completed the program, were invited to view another set of six video vignettes with men presenting similar problems to Phase 1. They again offered a diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis.RESULTS: In total, 64 general practitioners participated in the project, 57 GPs participated in Phase 1, and 45 in Phase 2. The Phase 1 education program was completed by 38 of the 57 (59%) participants. There were no significant differences in demographics between those who completed the program and those who did not. Factors determining whether management of cases was consistent with expert opinion were number of sessions worked per week (OR 0.78, 95% CI 0.67-0.90), site of clinical practice (remote practice, OR 2.25, 95% CI 1.01-5.03), number of patients seen per week (150 patients or more per week, OR 10.66, 95% CI 3.40-33.48), and type of case viewed. Completion of the Spaced Education did impact whether patient management was consistent with expert opinion (not completed, OR 0.88, 95% CI 0.5-1.56).CONCLUSIONS: The management of standardized patients by GPs was particularly unlikely to be consistent with expert opinion in the management of impotence and bony metastasis. There was no evidence from this standardized patient study that Spaced Education had an impact on the management of patients in this context. However, the program was not completed by all participants. Practitioners with a greater clinical load were more likely to manage cases as per expert opinion.

Resumo Limpo

ckground men treat prostat cancer australia can consult general practition gp advic symptom side effect time follow treatment howev evid men consist advis gps patient experi substanti unmet need reassur adviceobject intent studi evalu brief emailbas educ program gps manag standard patient present symptom side effect month year prostat cancer treatmentmethod gps view six pair video vignett actorpati depict men treat prostat cancer actorpati present problem attribut treatment cancer phase gps indic diagnosi state prescrib refer order test base diagnosi respons compar manag decis vignett recommend team expert prostat cancer phase gps invit particip emailbas educ program space educ focus prostat cancer particip receiv feedback compar progress perform particip studi phase gps regardless whether complet program invit view anoth set six video vignett men present similar problem phase offer diagnosi state prescrib refer order test base diagnosisresult total general practition particip project gps particip phase phase phase educ program complet particip signific differ demograph complet program factor determin whether manag case consist expert opinion number session work per week ci site clinic practic remot practic ci number patient seen per week patient per week ci type case view complet space educ impact whether patient manag consist expert opinion complet ci conclus manag standard patient gps particular unlik consist expert opinion manag impot boni metastasi evid standard patient studi space educ impact manag patient context howev program complet particip practition greater clinic load like manag case per expert opinion

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