Bairati I, Fillion L, Meyer F A, Héry C, Larochelle M
Laval University Cancer Research Center and Direction régionale de Santé Publique de la Capitale nationale, Quebec City, UK.
Eur J Cancer Care (Engl). 2006 May;15(2):183-93. doi: 10.1111/j.1365-2354.2005.00635.x.
An integrated network is currently being implemented in the province of Quebec in order to improve the cancer care continuum. In this context, formal trajectories for cancer patients through healthcare services are being established. The investigation of patients' perceptions of the healthcare continuum is essential as it allows us to identify the issue of continuity/discontinuity of health services. In addition, patients' perceptions of continuity of cancer care should be documented since they could influence the implementation of optimal trajectories through the healthcare services. An exploratory qualitative study was conducted in order to identify events, based on the perceptions of women with breast cancer, that made the patient progress more rapidly, facilitating events, or more slowly, impeding events, within the cancer care continuum. Two consecutive series of women receiving adjuvant radiation therapy in 2002 and 2003 at the University Hospital of Quebec City were recruited, for a total of 120 participants. A semi-structured interview was administered in order to identify women's perceptions regarding impeding and facilitating events during the detection, investigation and treatment periods of cancer, as well as the actors and reasons involved. Overall, 64% of women reported having at least one impeding event, while 68% reported at least one facilitating event. The periods most frequently affected by impeding or facilitating events were the investigation period, followed by the treatment period. The main stages affected by impeding or facilitating events were the scheduling of an appointment, during the investigation period, and the onset of treatment. Impeding events particularly affected the scheduling of mammography, the initial exam of the investigation for breast cancer, as well as the onset of radiation treatment. On the other hand, facilitating events mainly occurred at the time of the scheduling of medical consultations with specialists, during the investigation period, and of the onset of surgery. Finally, women generally perceived that impeding events were due to a lack in the availability of services and that facilitating events resulted from human intervention. Patients' perceptions, such as those regarding the importance of human intervention in the process of continuity of care, should be taken into account by healthcare authorities in charge of implementing cancer control programmes.
魁北克省目前正在实施一个综合网络，以改善癌症护理的连续性。在此背景下，正在为癌症患者建立通过医疗服务的正式轨迹。调查患者对医疗护理连续性的看法至关重要，因为这使我们能够识别医疗服务连续性/不连续性的问题。此外，应该记录患者对癌症护理连续性的看法，因为它们可能会影响通过医疗服务实施最佳轨迹。为了根据乳腺癌女性的看法确定在癌症护理连续过程中使患者进展更快的促进事件或进展更慢的阻碍事件，开展了一项探索性定性研究。招募了2002年和2003年在魁北克市大学医院接受辅助放疗的连续两批女性，共120名参与者。进行了一次半结构化访谈，以确定女性对癌症检测、调查和治疗期间阻碍和促进事件的看法，以及相关的行为者和原因。总体而言，64%的女性报告至少有一个阻碍事件，而68%的女性报告至少有一个促进事件。受阻碍或促进事件影响最频繁的时期是调查期，其次是治疗期。受阻碍或促进事件影响的主要阶段是调查期的预约安排和治疗开始。阻碍事件尤其影响乳腺癌调查的初始检查乳房X光检查的安排以及放疗的开始。另一方面，促进事件主要发生在调查期与专科医生进行医疗咨询的预约安排时以及手术开始时。最后，女性普遍认为阻碍事件是由于服务可用性不足，而促进事件是由于人为干预。负责实施癌症控制计划的卫生当局应考虑患者的看法，例如那些关于人为干预在护理连续性过程中的重要性的看法。
