Saint-Jacques N, Younis T, Dewar R, Rayson D
Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, QEII Health Sciences Centre, 560 Bethune Building, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9.
Br J Cancer. 2007 Jan 15;96(1):162-8. doi: 10.1038/sj.bjc.6603523. Epub 2006 Dec 19.
Measurement of care time intervals is complex, being influenced by many factors. The definition of the care interval monitored can also bias the detection of changes in waits. The implications of using different care interval definitions to report wait times and identify delays in care provision were examined using a retrospective chart review of 637 women with surgically treated breast cancer who were referred to a cancer centre between September 1999 and 2000 or September 2003 and 2004. Overall waits between detection and adjuvant treatment increased by 12 days over the two periods, but their exact location and cause(s) could not be determined at such a low-resolution interval. At higher resolutions of care intervals, reporting the comprehensive sequence of care events, the prolongation was mainly associated with delayed access to surgery (4 days) and delivery of adjuvant chemotherapy (4 days). The latter went unnoticed when waits were reported at intermediate (referral to adjuvant treatment) and low (detection to adjuvant treatment) resolutions. Disease stage and type of first adjuvant treatment consistently and significantly influenced the length of waits. Comprehensive monitoring of the entire care path is essential to effectively prioritize interventions, assess their outcomes and optimise access to cancer care.
护理时间间隔的测量很复杂，会受到许多因素的影响。所监测的护理间隔的定义也可能会使等待时间变化的检测产生偏差。通过对1999年9月至2000年9月或2003年9月至2004年9月期间转诊至癌症中心接受手术治疗的637例乳腺癌女性患者的病历进行回顾性分析，研究了使用不同护理间隔定义报告等待时间和识别护理提供延迟的影响。在这两个时期，从发现到辅助治疗的总体等待时间增加了12天，但在如此低分辨率的间隔下，无法确定其确切位置和原因。在更高分辨率的护理间隔下，报告护理事件的完整序列时，等待时间延长主要与手术延迟（4天）和辅助化疗延迟（4天）有关。当在中等分辨率（转诊至辅助治疗）和低分辨率（发现至辅助治疗）下报告等待时间时，后者未被注意到。疾病阶段和首次辅助治疗类型始终且显著影响等待时间的长短。对整个护理路径进行全面监测对于有效确定干预措施的优先级、评估其结果以及优化癌症护理的可及性至关重要。
