Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Am Geriatr Soc. 2009 Nov;57 Suppl 2(Suppl 2):S265-8. doi: 10.1111/j.1532-5415.2009.02508.x.
To examine data from advanced cancer patients and their oncologists regarding patient age-related differences in patient and oncologist perspectives on involvement of primary care physicians (PCPs) in aspects of cancer management.
Randomized controlled trial of a support intervention for patients with late-stage cancer treated in two teaching hospital-based cancer clinics caring for underserved populations.
Three hundred fifty-seven patients who had an oncologist and PCP enrolled 2 to 3 months after an advanced cancer diagnosis.
Sociodemographic data and structured interviews were used to assess patients' perceptions of PCP involvement in care discussions and decision-making and satisfaction with that involvement, oncologists' beliefs about how involved PCPs should be in these discussions and decisions, and their shared care practices.
Older patients (>or=65) were more likely to have a PCP (P=.02). Patients reported a broad range of perceived PCP involvement and satisfaction with that involvement. Greater involvement was associated with greater satisfaction (P<.001). Half of oncologists reported themselves as PCP for more than 25% of their patients. Approximately half of oncologists reported that more older than younger patients had PCPs, yet only 20% reported differences in PCP involvement or in their communication with PCPs for older late-stage patients.
Results support involvement of PCPs in advanced cancer care and demonstrate variable perspectives on PCP involvement. Matching patient preferences and practices may improve satisfaction. Clarification of elements in the partnership between patients, PCPs, and oncologists will inform efforts to optimally care for older patients with advanced cancer.
调查晚期癌症患者及其肿瘤医生的数据，了解患者和医生对初级保健医生（PCP）参与癌症管理方面的看法在多大程度上因患者年龄而异。
对两家教学医院癌症诊所为服务不足人群提供的晚期癌症患者进行的支持性干预的随机对照试验。
357 名在晚期癌症诊断后 2 至 3 个月接受肿瘤医生和 PCP 治疗的患者。
使用社会人口统计学数据和结构访谈评估患者对 PCP 参与护理讨论和决策以及对参与程度的满意度、肿瘤医生对 PCP 应在这些讨论和决策中参与程度的信念，以及他们的共同护理实践。
年龄较大的患者（≥65 岁）更有可能有 PCP（P=.02）。患者报告了广泛的 PCP 参与程度和对参与程度的满意度。更大的参与度与更高的满意度相关（P<.001）。一半的肿瘤医生报告自己是超过 25%的患者的 PCP。大约一半的肿瘤医生报告说，更多的老年患者比年轻患者有 PCP，但只有 20%的肿瘤医生报告说，老年晚期患者的 PCP 参与程度或与 PCP 的沟通存在差异。
结果支持 PCP 参与晚期癌症护理，并展示了对 PCP 参与的不同看法。匹配患者的偏好和实践可能会提高满意度。明确患者、PCP 和肿瘤医生之间伙伴关系的要素将为努力为老年晚期癌症患者提供最佳护理提供信息。
