Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7461, 1700 Martin Luther King Blvd, Room 316, Chapel Hill, NC 27599, USA.
J Cancer Surviv. 2011 Sep;5(3):271-82. doi: 10.1007/s11764-011-0180-z. Epub 2011 May 10.
The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care.
Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits.
Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions.
The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care.
Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.
本研究旨在描述 8 个 LIVESTRONG 生存研究中心卓越网络（COE）站点的生存护理模式，并确定影响生存护理的障碍和促进因素。
使用慢性病护理模型（CCM）的框架，对 COE 进行了定量和定性方法的调查。方法包括文献回顾、对 39 名参与者的电话访谈、对 40 名参与者的在线慢性病护理评估（ACIC）调查，以及三次现场访问。
定性访谈中出现了几个总体主题，并通过定量方法得到证实。支持生存护理的卫生系统因素包括组织和领导层的承诺以及医疗团队各级的项目支持者。系统障碍包括报销问题、缺乏空间以及领导层承诺支持临床实践的改变，以及在临床工作人员中拥有项目“拥护者”的需求。多种护理模式包括独立的生存诊所和综合模式以及咨询模式。ACIC 调查的 COE 得分显示，生存护理得到了“合理的支持”；然而，临床信息系统领域的发展最不完善。尽管 ACIC 的调查结果表明对自我管理的支持“合理”，但定性分析显示，自我管理支持主要限于诊所教育和咨询课程中提供的健康促进，只有少数 COE 为患者提供自我管理工具和干预措施。
CCM 框架捕捉了这些 COE 的经验和挑战，并深入了解了国家癌症研究所指定的综合癌症中心背景下的生存护理现状。调查结果表明，癌症患者和提供者可以从临床信息系统中受益，该系统将更好地确定生存护理的候选者，并提供及时的信息。此外，一个关键的发展领域是临床护理之外的自我管理支持。
癌症幸存者可能会从了解 LIVESTRONG 卓越中心在制定癌症生存护理计划和模式方面面临的经验和挑战中受益，这些发现可能会为患者和护理人员寻求、评估和倡导旨在满足其需求的高质量生存计划提供信息。
