MAASTRO Clinic, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, P.O. Box 3035, 6202 NA Maastricht, The Netherlands.
Acta Oncol. 2010 Apr;49(3):328-37. doi: 10.3109/02841860903536002.
Clinical guidelines for the follow-up after breast cancer recommend frequent outpatient clinic visits to be examined for a possible recurrence or a second primary breast tumour, and to receive information and psychosocial support. However, needs and preferences for follow-up may differ between patients, raising the question whether the current 'one size fits all' approach is appropriate. This study explored patients' preferences for follow-up. Patients and methods. A discrete choice experiment survey with 16 choice tasks was filled out by 331 breast cancer patients. Each choice task consisted of two hypothetical follow-up scenarios for the first year after treatment, described by levels of the following characteristics; attendance at an educational group programme, frequency of visits, waiting time, contact mode, and type of healthcare provider. Results. The healthcare provider and contact mode were the most important characteristics of follow-up to patients. The medical specialist was the most preferred to perform the follow-up, but a combination of the medical specialist and breast care nurse alternating was also acceptable to patients. Face-to-face contact was strongly preferred to telephone contact. Follow-up visits every three months were preferred over visits every four, six, or 12 months. Heterogeneity in preference between patients was strong, especially for the healthcare provider and attendance at an educational group programme. Age, education, and previous experience with follow-up characteristics influenced preferences, but treatment modality did not. Conclusion. The results of this study show that overall patient satisfaction would not differ significantly if patients have follow-up by medical specialist and breast care nurse alternating compared to follow-up by a medical specialist only. Furthermore, we found heterogeneity in preferences for most attributes, indicating that one strategy does not fit all. Individualised follow-up seems to offer the potential for significant increases in patient satisfaction.
临床指南建议乳腺癌患者进行随访，以检查是否有复发或第二原发乳腺癌的可能，并提供信息和心理社会支持。然而，患者对随访的需求和偏好可能存在差异，这引发了一个问题，即目前的“一刀切”方法是否合适。本研究旨在探讨患者对随访的偏好。
患者和方法。对 331 名乳腺癌患者进行了 16 项选择任务的离散选择实验调查。每个选择任务由治疗后第一年的两种假设随访方案组成，通过以下特征的水平来描述：参加教育小组计划、就诊频率、等待时间、联系方式和医疗服务提供者类型。
结果。医疗服务提供者和联系方式是患者随访的最重要特征。医疗专家是最受欢迎的随访者，但医疗专家和乳腺护理护士交替进行也能被患者接受。面对面接触比电话接触更受欢迎。患者更喜欢每三个月就诊一次，而不是每四个月、六个月或一年就诊一次。患者之间的偏好存在很大差异，尤其是在医疗服务提供者和参加教育小组计划方面。年龄、教育程度和之前的随访特征体验影响了偏好，但治疗方式没有影响。
结论。本研究结果表明，如果患者由医疗专家和乳腺护理护士交替进行随访，而不是仅由医疗专家进行随访，患者的总体满意度不会有显著差异。此外，我们发现大多数属性的偏好存在异质性，这表明一种策略并不适用于所有人。个体化随访似乎有潜力显著提高患者的满意度。
