Laboratory Screening Flashcards
Define shared decision making (or informed decision making) and describe the goals for the patient according to the USPSTF.
patient and clinician exchange information both contribute to the decision-making process, conclude about a plan of action
Goals
- Understand the risk/seriousness of the illness to be prevented
- Understand the preventive services, including the harms, benefits, alternative options, and uncertainties
- Benefit vs harm (for individual)
- Make decision based on comfort level
Discuss the benefits of the shared decision-making model and further how this may help to improve patient outcomes.
- Higher satisfaction
- less conflict in making decisions
- Autonomy (pt)
- Trust
- Increase adherence to care plans
- Realistic understanding about the harms and benefits of preventive care
- Improve patient outcomes: early detection and intervention, assess at risk populations
Indicate the barriers to shared decision making and discuss ways in which the clinician may attempt to overcome these barriers.
- Pt cant understand complex medical = patient education
- Doc not sure about evidence for benefit = evidence-based clinic protocols
- Limited time = (nurses) decision aids for review while awaiting the clinician
- Lack of reimbursement = screening fairs or non-profit organizations
Explain the rationale for offering or not offering screening laboratory tests.
- Pt want/deserve info
- Our responsibility to offer only if theres reasonable probability of more benefit than harm
Low value services
- Unacceptably high harm
- Modest/no benefit (min/no clinical benefit, small number could benefit)
- Uncertain benefit (not enough evidence, unfocused target)
Harms of preventive service
- Harm unacceptably high (HRT = out of favor, PCR = over treatment)
- Over dx/over tx
Blood Glucose
Patient Population
- All adults 40-70 (overweight or obese)
- Higher risk for developing diabetes (early screen)
Family Hx
Personal hx of gestational diabetes or polycystic ovary syndrome
Recommendation
- Overweight or obese or have risk factors→ should be routinely offered as part of periodic health screening
- Normal test = Intervals of every 3 years
Types of Screening tests
Fasting Plasma Glucose (FPG) test
Total Cholesterol and Lipid Profiles
Patient Population
- Adults aged 40 to 75 years
- 21 to 39 years, clincians use clinical judgement
Recommendations
- All adults 20 years and older should have fasting lipid profile At least every 5 years as part of assessment of CVD risk
- Shorter intervals in those closer to CVD risk
- Longer intervals with no increased CVD risk ppl
Types of Screening tests
Fasting lipid profile: total cholesterol, LDL-C (bad fat)
Human Immunodeficiency Virus
Patient Population
- Adolescents and adults 15-65 years (sexually active)
- Those in high risk settings
(STI clinics, Correctional facilities, Homeless shelters)
- Universal screening to all pregnant women in 1st trimester
- Rapid screening for women in labor with unknown HIV status
Recommendations
- Annually, counseling = pretest and posttest, STI prevention
- Increased risk
MSM after 1975
M/F having sex with multiple partners, unprotected
past/present injection drug users
Prostitue
Partners with HIV infected, IV drug users, bisexual
Persons being treated for STIs
History of blood transfusion between 1978 and 1985
Types of screening test
- ELISA screening
- Followed by Western Blot for confirmation
Syphilis
Patient Population
- MSM, or engage in high-risk sexual behaviors = every 3 months screening
- Prostitue
- Persons who exchange sex for drugs
- Adults in correctional facilities
Recommendations
- All asymptomatic high-risk adolescents and non-pregnant adults
- MSM or persons living with HIV
- All pregnant women-first prenatal visit
- 3rd trimester and at birth for high risk women
Types of screening tests
- Venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) for screening
- Antibody absorption assay (FTA-ABS) or Treponema pallidum particle agglutination (TP-PA) for confirmation
Prostate Cancer Screening With Prostate-Specific Antigen
Patient Population and Recommendations
- Average-risk men 50-70 years with at least a 10-year life expectancy
- High-risk men between 40-70 years (AA or men with first-degree relative with prostate cancer high risk at age 40)
Types of screening tests
- Prostate-specific antigen (PSA) and digital rectal examination (DRE)
Have to do both screens
- Confirmation by prostate biopsy
Risk versus benefits
Pap Smears
Patient population
- women aged 21 to 65yrs (intact cervix)
- Age 30-65 who have HPV testing along with cytology every 5 years
Recommendations
- High risk for HPV and cervical dysplasia = annual screening
(Documented HPV infections, hx of abnormal pap smears, early onset of intercourse, large number of sexual partners, cigarette smoking)
- Low risk for cervical cancer every 2-3 years
- Women with adequate screening and normal smears can stop at 65
Types of screening tests
- Inspect cervix and external os for ulcerations, nodules, masses, bleeding, leukoplakia, or discharge
- Complete pap test = collection of specimens from the endocervical canal and the ectocervix
- Reports the presence of cellular atypia, dysplasia, or carcinoma
Screening for Gonorrhea and Chlamydia
Patient population
- All sexually active women 24 years and younger, women at high risk, pregnant women
Recommendations
- Screening of nonpregnant women- annually
- Screening of pregnant women in first trimester, followed by repeat screening in third trimester for those at high risk
- Men- adolescent and young adult males who have sex with males who engage in high-risk sexual behaviors or settings.
Types of screening tests
- Culture, nucleic acid amplification tests, and nucleic acid hybridization tests
- Endocervical canal specimen or urine specimen/urethral swab in women and urethral swabs/urine specimen in men
- Based on pt sexual behaviors can also swab: posterior nasopharynx and tonsillar arches, anal samples
Colorectal Cancer Screening
Patient population
- All adults 50 to 75 years of age
Types of screening tests
- Fecal occult blood test (FOBT) every year
- Flexible Sigmoidoscopy every 5 years
- Combination of 1. And 2.
- Colonoscopy every 10 years
More often for pts: with first degree family hx of CRC, or hereditary polyposis syndromes
- Double-contrast barium enema every 5 years
Rarely used for screening
Fecal Occult Blood Testing
Patient population
- Screening for microscopic blood in stool
Types of screening tests
- FOBT (performed in exam room with DRE-card with guaiac)
- Home test (3 cards with guaiac, collect 2 samples from 3 separate consecutive stool samples, mail the cards to office/lab)
Sigmoidoscopy and Colonoscopy
- Endoscopy (principle screening for adenomatous polyps and CRC)
- Detect and remove precancerous polyps
Sigmoidoscopes
- measure 60 to 65cm in length
- inspect distal 3rd of colon (colorectal malignancies most likely occur here)
- Anxiolytics or sedative can be prescribed day of (reduce anxiety)
CRC mortality by 60%
Colonscopy
- Can inspect entire colon to cecum (conscious sedation)
- CRC mortality by 60%
Preparation = bowel evacuation 24-38hrs before
Mammography
Patient populations
- All women 50-74 years, biennial mammography
- Discuss the risks and benefits of screening for W 40 to 50 years
- Screening offers limited value to those with <10 yr life expectancy
Recommendations
- Clinicians should screen if pts have increased risk for potentially harmful mutations; refer them for genetic counseling= BRCA mutation
