King M, Jones L, McCarthy O, Rogers M, Richardson A, Williams R, Tookman A, Nazareth I
Department of Mental Health Sciences, Royal Free and University College Medical School, Royal Free Campus, London, UK.
Br J Cancer. 2009 Jan 27;100(2):274-80. doi: 10.1038/sj.bjc.6604836. Epub 2008 Dec 23.
High experienced continuity of care in patients with cancer is associated with lower needs for care, better quality of life and better psychological outcomes. We developed and evaluated an intervention to improve experienced continuity. The intervention, consisted of (1) a 17-item patient-completed continuity assessment; (2) feedback to clinical nurse specialists and action to address the needs identified. Multidisciplinary team meetings and oncology outpatient clinics were observed, and patients and staff were interviewed. After qualitative work and reliability testing, the intervention was evaluated in a feasibility trial. Sixty-one patients provided data for analysis. No statistically significant differences were found in patients' experienced continuity between the trial arms, but important trends were seen in measures of needs for care in favour of those receiving the intervention. Feeding back findings from the continuity assessment to clinicians reduced patients' needs for care. Our results indicate that an intervention to target patients' experiences of continuity can reduce their subsequent needs for care. However, overcoming barriers to organisational change and addressing some patients' hesitation to report their continuity difficulties must be considered when implementing such an intervention. A phase III trial targeting patients with inadequate experienced continuity of care is recommended.
癌症患者获得高度持续的专业照护与较低的照护需求、更好的生活质量以及更佳的心理状况相关。我们研发并评估了一项旨在改善实际照护持续性的干预措施。该干预措施包括：（1）一份由患者填写的包含17项内容的持续性评估表；（2）向临床护理专家反馈评估结果，并针对所发现的需求采取行动。我们观察了多学科团队会议和肿瘤门诊，并对患者及工作人员进行了访谈。经过定性研究和信度测试后，我们在一项可行性试验中对该干预措施进行了评估。61名患者提供了分析数据。试验组之间患者实际感受到的照护持续性并无统计学上的显著差异，但在照护需求指标方面出现了有利于接受干预措施患者的重要趋势。将持续性评估结果反馈给临床医生可降低患者的照护需求。我们的结果表明，针对患者照护持续性体验的干预措施可降低其后续的照护需求。然而，在实施此类干预措施时，必须考虑克服组织变革的障碍以及应对一些患者不愿报告其照护持续性困难的问题。建议针对照护持续性体验不足的患者开展III期试验。
