Sheppard C, Higgins B, Wise M, Yiangou C, Dubois D, Kilburn S
Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Eur J Oncol Nurs. 2009 Feb;13(1):2-8. doi: 10.1016/j.ejon.2008.11.005. Epub 2008 Dec 31.
To examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical reviews.
A parallel randomised controlled trial was used to examine point of need access to specialist care via the nurse specialist, compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis. A total of 237 patients were recruited to the study.
Outcome measures at baseline, 9 and 18 months included psychological morbidity using the GHQ12 questionnaire, quality of life using the FACT-B plus endocrine subscale, fear and isolation. An analysis of covariance was used to detect changes over time. Recurrences and methods of detection were recorded as secondary outcome measures.
Two hundred and fourteen patients completed the study. Overall patients were not exposed to risks of increased psychological morbidity (p=0.767) or decline of quality of life (p=0.282) when routine review was discontinued and no significant differences were detected during an 18-month period. Patients not receiving regular review did not feel isolated, and at the end of 18 months did not wish to return to 6-monthly clinical reviews. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit.
Point of need access is acceptable to the majority of patients. Although a third of patients may wish to maintain a regular review, patient choice is important. Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life. Patients do not appear to be compromised in terms of early detection of recurrence. Point of need access can be provided by suitably trained specialist nurses and provides a fast, responsive management system at a time when patients really need it.
基于按需就诊的理念检验一种针对乳腺癌患者的护理模式，并调查该模式与常规每6个月进行一次临床复查相比的有效性。
采用平行随机对照试验，将通过专科护士按需就诊专科护理与乳腺癌诊断后第二年基于医院的常规每6个月进行一次临床复查进行比较。共有237名患者被纳入该研究。
在基线、9个月和18个月时的结局指标包括使用GHQ12问卷评估心理疾病、使用FACT-B加内分泌子量表评估生活质量、恐惧和孤独感。采用协方差分析来检测随时间的变化。复发情况和检测方法作为次要结局指标进行记录。
214名患者完成了研究。总体而言，当停止常规复查时，患者未面临心理疾病增加（p = 0.767）或生活质量下降（p = 0.282）的风险，并且在18个月期间未检测到显著差异。未接受定期复查的患者没有感到孤独，在18个月结束时也不希望恢复每6个月进行一次的临床复查。复发情况和短症状史表明，观察到的复发在常规就诊时不太可能被检测到。
按需就诊为大多数患者所接受。尽管三分之一的患者可能希望维持定期复查，但患者的选择很重要。研究结果表明，在乳腺癌诊断2年后，没有证据支持定期临床复查能改善心理疾病或生活质量这一观点。患者在复发的早期检测方面似乎并未受到影响。经过适当培训的专科护士可以提供按需就诊服务，并在患者真正需要时提供一个快速、响应式的管理系统。
