Koch Uwe
Psycho-Oncology and Health Care Research, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Psychooncology. 2008 Jun;17(6):533-7. doi: 10.1002/pon.1359.
Remarkable changes of health-care systems, increasing costs of health care and of social inequality in modern societies, an aging population and the increase of chronic illnesses such as cancer implicate various future challenges for the provision of health care. Health-care research aims to improve the effectiveness and efficiency of patient-oriented services involving the evaluation of innovative treatment approaches and settings. It deals with the patients' path through different areas of health-care systems in order to identify significant factors for the provision of quality assurance of structures and resources concerning treatments, processes and health outcomes. Health-care research focusses on three main topics that play an important role for quality management: (1) the admission to health-care services and assessment strategies including indication, utilization and specificity of settings and target groups; (2) the treatment process including the implementation, standardization and flexibility of services and dose-effect relationship of interventions; (3) health-care outcome including effectiveness and efficiency of interventions and services, the cost-benefit relationship and the transfer from research to health-care practice. Given the objectives of health-care research, the topics of health-care research in psychosocial care for cancer patients include the study of structural conditions of psycho-oncological services, the epidemiology of distress and mental disorders and the subjective need of psycho-oncological support in cancer patients, the improvement of psycho-oncological measures and assessment strategies in daily treatment, the study of psycho-oncological interventions under routine conditions, and quality assurance. Requirements of future health-care research and developments of psycho-oncology including aspects of orientation, strategies, health-care equity, and resources are discussed.
现代社会中，医疗保健系统发生了显著变化，医疗保健成本不断增加，社会不平等加剧，人口老龄化以及癌症等慢性病的增多给医疗保健的提供带来了各种未来挑战。医疗保健研究旨在提高以患者为导向的服务的有效性和效率，包括对创新治疗方法和环境的评估。它关注患者在医疗保健系统不同领域的就医过程，以便确定在治疗、流程和健康结果方面提供结构和资源质量保证的重要因素。医疗保健研究聚焦于质量管理中发挥重要作用的三个主要主题：（1）医疗保健服务的准入和评估策略，包括适应症、环境和目标群体的利用情况及特殊性；（2）治疗过程，包括服务的实施、标准化和灵活性以及干预措施的剂量效应关系；（3）医疗保健结果，包括干预措施和服务的有效性和效率、成本效益关系以及从研究到医疗保健实践的转化。鉴于医疗保健研究的目标，癌症患者心理社会护理中的医疗保健研究主题包括心理肿瘤服务的结构条件研究、痛苦和精神障碍的流行病学以及癌症患者对心理肿瘤支持的主观需求、日常治疗中心理肿瘤措施和评估策略的改进、常规条件下心理肿瘤干预措施的研究以及质量保证。本文还讨论了未来医疗保健研究的要求以及心理肿瘤学的发展，包括方向、策略、医疗保健公平性和资源等方面。
