Jacobsen Paul B
Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
Psychooncology. 2009 Jan;18(1):6-13. doi: 10.1002/pon.1468.
With numerous studies demonstrating that psychosocial care reduces distress and improves quality of life, practitioners have an obligation to treat cancer patients in a manner consistent with this evidence. Although the rationale is straightforward, major challenges exist in achieving the goal of translating research into clinical practice. One challenge has been the nature of the evidence, with many studies of psychosocial interventions characterized by poor methodological quality, absence of eligibility criteria specifying heightened distress, and minimal consideration of dissemination potential. A second challenge has been to make practitioners aware of relevant evidence. Targeted efforts at dissemination, such as the issuance of clinical practice guidelines and evidence-based recommendations and the distribution of intervention materials via the Internet, appear to be more effective than passive efforts in providing practitioners with useful information. Perhaps the most challenging aspect has been to persuade practitioners to change how they practice. One approach currently under development would allow practitioners and health-care organizations to perform self-evaluations of the quality of their psychosocial care based on review of medical records. Feedback showing quality of care to be less than optimal is likely to motivate change, especially if the quality indicators assessed are considered to be important and reliable and point to specific actions that can be taken. The use of evidence to promote changes in clinical practice represents one of the major ways in which the field of psycho-oncology can fully realize its potential to positively affect the lives of people with cancer.
众多研究表明，心理社会关怀可减轻痛苦并提高生活质量，从业者有义务以符合这一证据的方式治疗癌症患者。尽管理由很简单，但在实现将研究转化为临床实践这一目标方面存在重大挑战。一个挑战是证据的性质，许多心理社会干预研究的方法学质量较差，缺乏指定高度痛苦的资格标准，并且对传播潜力的考虑极少。第二个挑战是让从业者了解相关证据。有针对性的传播努力，如发布临床实践指南和基于证据的建议，以及通过互联网分发干预材料，在为从业者提供有用信息方面似乎比被动努力更有效。也许最具挑战性的方面是说服从业者改变他们的实践方式。目前正在开发的一种方法将允许从业者和医疗保健组织根据病历审查对其心理社会护理质量进行自我评估。显示护理质量低于最佳水平的反馈可能会促使改变，特别是如果评估的质量指标被认为是重要且可靠的，并指出可以采取的具体行动。利用证据促进临床实践的改变是心理肿瘤学领域能够充分发挥其对癌症患者生活产生积极影响潜力的主要方式之一。
