我国结直肠癌筛查的影响因素文献分析及思考  

Literature Review and Consideration of Factors Influencing Colorectal Cancer Screening in China

作　　者：安锦慧 孙治平[2] 李云涛[1] 鲁雪梅 季国忠[1] AN Jinhui;SUN Zhiping;LI Yuntao;LU Xuemei;JI Guozhong(Department of General Practice,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;Health Management Center,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院全科医学科,江苏省南京市210011 [2]南京医科大学第二附属医院健康管理中心,江苏省南京市210011

出　　处：《中国全科医学》2020年第23期2877-2882,共6页Chinese General Practice

基　　金：江苏省医院管理创新研究重点课题(JSYGY-2-2019-16)。

摘　　要：背景目前全国结直肠癌发病率呈逐年上升的趋势,结直肠癌的疾病负担不断加重。然而我国早期结直肠癌筛查整体参与率偏低,居民依从性较差。目的了解结直肠癌筛查的影响因素,为制定更好的筛查策略提供设计依据。方法计算机检索中国知网、万方数据知识服务平台、维普期刊全文、中国生物医学文献数据库、PubMed等数据库,检索时间为建库至2019-05-31。纳入影响居民结直肠癌筛查依从性的现况调查或横断面研究。提取资料,并进行文献质量评价。采用定性荟萃分析方法分析居民拒绝结直肠癌筛查的影响因素。结果共纳入21篇文献,178 196例调查对象。文献质量评价得分为2~8分。分析结果提示:缺乏结直肠癌及筛查相关知识的认知因素、恐惧筛查等心理因素、害怕筛查并发症或不适性、不信任社区医院及医生没有推荐筛查等社区医院因素、筛查费用昂贵等其他因素是导致居民拒绝结直肠癌筛查的因素。结论加强宣传教育、建设全-专团队、开发随访-反馈系统、政府-保险-企业-社区-家庭五位一体、推广乙状结肠镜检查,将有利于改善患者筛查依从性。Background In China,the incidence of colorectal cancer is gradually increasing across the country,as is the case with the disease burden of colorectal cancer.However,the rate of early colorectal cancer screening and adherence to the screening are both low in residents.Objective To identify the influencing factors of colorectal cancer screening,to provide scientific evidence for developing better screening strategies.Methods CNKI,Wanfang Data,VIP,CBM,PubMed and other databases were searched from inception to May 31,2019 for cross-sectional studies about factors affecting the adherence to colorectal cancer screening.Data extraction and quality assessment were performed.Qualitative meta-analysis was used to analyze the factors influencing the adherence to colorectal cancer screening.Results A total of 21 studies were included,involving 178196 residents.Quality assessment score was 2 to 8.The results suggested that lack of knowledge about colorectal cancer and colorectal cancer screening and other cognitive factors,fear of screening and screening-related complications or discomfort and other psychological factors,distrust of community hospitals or receiving no relevant doctor's advice and other community hospitalrelated factors,and cost of screening were the main factors associated with low adherence to screening.Conclusion To improve the adherence to colorectal cancer screening,suggested facilitators include strengthening publicity and education,building the general practitioner-specialist screening team,developing a follow-up and response system,and providing governmentinsurance-enterprise-community-family combined interventions,and promoting sigmoidoscopy.

关 键 词：结直肠肿瘤 筛查 依从性 全科医生 

分 类 号：R735.34[医药卫生—肿瘤]