过度诊断的概念及影响因素研究综述

Research Review of Concepts and Influencing Factors of Overdiagnosis

“过度诊断”指无临床症状的人被诊断出无进展且不会造成健康损害的疾病,而该疾病诊断未能对个体带来净健康获益。与之相关的“过度医疗”“过度检查”“过度治疗”“假阳性”“误诊”等概念同样需要关注。通过综述国内外文献,归纳不同视角下过度诊断的影响因素,如患者层面的健康信念、对疾病的焦虑,服务提供者对患者最好结局的追求、医患沟通,医疗卫生系统的模式,社会层面的医疗文化和传统价值观等。认为应该进一步探索过度诊断的内涵定义、形成机制及其社会影响,针对疾病高风险人群开展精准筛查,审慎使用有创检查和治疗,促进医患共同决策和培养正确的社会医疗文化。

"Overdiagnosis"refers to an asymptomatic individual being diagnosed with a disease that does not progress or cause health damage,failing to provide net health benefit to individual.It is also worthwhile paying attention to the concepts like"medical overuse""over testing""overtreatment""false-positive"and"misdiagnosis"related to"overdiagnosis".Through reviewing the relevant studies at home and abroad,the influencing factors of overdiagnosis in different aspects were summarized,such as,health belief and anxiety about disease of patient,physician-patient communication and pursuit of the best outcome for patients of service provider,the mode of healthcare system,medical culture and traditional values at social level and so on.This article puts forward the following suggestions,exploring the definition,formation mechanism and social impact of overdiagnosis further,carrying out precise screening for high-risk population and using invasive tests and treatments deliberatively,promoting shared decision-making and cultivating a correct social medical culture.