【摘要】 目的 分析医生对甲状腺癌过度诊断的认知现状及影响因素,为规范甲状腺癌诊疗流程提供参考。方法基于委托代理理论,自主设计问卷,从过度诊断的认知及风险水平、模拟治疗方案的选择等维度,对175名甲状腺癌诊治临床医生进行调查。采用卡方检验分析过度诊断风险行为影响因素。结果 31.43%的医生对甲状腺癌诊断领域是否存在过度诊断不清楚;62.86%的医生在无症状甲状腺结节治疗中维持“早发现、早治疗”的传统理念。医生聘用形式、过度诊断认知水平、道德风险合理化水平、意向水平及行为水平等因素在医生低风险甲状腺癌治疗方案选择意愿上的差异具有统计学意义(P<0.05)。结论 医生对甲状腺癌过度诊断现状认知不足,医疗机构应通过开展甲状腺癌过度诊断相关认知培训、完善聘用考核制度以及推进医患共同决策等方式,降低医生过度诊断道德风险水平,防范医生低危甲状腺癌过度诊断风险。更多还原

【Abstract】 Objective To analyze the current cognitive status and influencing factors of doctors regarding the overdiagnosis of thyroid cancer,providing references for standardizing the diagnosis and treatment process of thyroid cancer.Methods Based on the principal-agent theory,a self-designed questionnaire was employed to survey 175 clinicians involved in the diagnosis and treatment of thyroid cancer.The survey covered dimensions such as cognitive awareness and perceived risk levels of overdiagnosis,as well as the selection of simulated treatment plans.The chi-squaretest was used to analyze the influencing factors of risk behaviors related to overdiagnosis.Results 31.43% of the doctors were unclear about whether overdiagnosis existed in the field of thyroid cancer diagnosis; additionally,62.86% of the doctors adhered to the traditional concept of "early detection,early treatment" in the management of asymptomatic thyroid nodules.Factors including employment status,cognitive level of overdiagnosis,rationalization level of moral hazard,intention level,and behavior level showed statistically significant differences(P<0.05) in doctors’ willingness to choose low-risk treatment plans for thyroid cancer.Conclusion Doctors have insufficient awareness of the current situation of overdiagnosis of thyroid cancer.Medical institutions should reduce the level of moral hazard associated with overdiagnosis by doctors and prevent the risk of overdiagnosis in low-risk thyroid cancer through measures such as conducting cognitive training related to overdiagnosis of thyroid cancer,improving employment and assessment systems,and promoting shared decision-making between doctors and patients.更多还原