Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Cancer Surviv. 2011 Dec;5(4):358-70. doi: 10.1007/s11764-011-0196-4. Epub 2011 Oct 4.
This study evaluates the concordance of treatment summaries (TSs) and survivorship care plans (SCPs) delivered to breast cancer survivors within the LIVESTRONG™ Network of Survivorship Centers of Excellence with Institute of Medicine (IOM) recommendations and describes additional structure/process variables.
Seven NCI-designated comprehensive cancer centers and six community-based centers participated. TS/SCPs for 65 patients were rated against IOM recommendations using a study-derived checklist, and surveys were administered to better understand the structure and process of delivering TSs/SCPs.
On average, fewer than half of IOM content recommendations were met for TSs (M = 46%) and less than two thirds for SCPs (M = 59%). No sites achieved ≥75% overall concordance with IOM recommendations for TSs and only two of 13 met this criterion for SCPs. Content domain scores across sites varied widely, as did the number of sites addressing domain content with ≥75% concordance. Nonetheless, resources required for document preparation and delivery were substantial.
Gaps in concordance with IOM recommendations exist even in dedicated survivorship centers. A substantial time burden was also noted. Further research is needed to determine which informational elements are essential, to develop and test strategies for improving efficiency and reach, and to determine if outcomes of survivorship care planning warrant the resources required in their preparation and delivery. IMPLICATIONS FOR SURVIVORS: TSs and SCPs have been recommended for all cancer survivors. Essential elements must be determined, approaches made more efficient, outcome improvements demonstrated, and cost-benefit analyses determined before survivors should expect widespread implementation of this recommendation for survivorship care.
本研究评估了 LIVESTRONG 网络卓越生存中心与医学研究所（IOM）建议提供的乳腺癌幸存者的治疗总结（TS）和生存护理计划（SCP）之间的一致性，并描述了其他结构/流程变量。
7 个 NCI 指定的综合癌症中心和 6 个社区基础中心参与了这项研究。使用研究衍生的清单对 65 名患者的 TS/SCP 进行了 IOM 建议的评估，并进行了调查以更好地了解提供 TS/SCP 的结构和过程。
平均而言，TS 的 IOM 内容建议中不到一半得到满足（M=46%），SCP 则不到三分之二（M=59%）。没有一个站点的 TS 与 IOM 建议的总体一致性达到≥75%，只有 13 个 SCP 中有两个达到了这一标准。各站点的内容域评分差异很大，达到 75%一致性的域内容的站点数量也各不相同。尽管如此，文件准备和交付所需的资源还是相当多的。
即使在专门的生存中心，也存在与 IOM 建议不符的情况。还注意到了大量的时间负担。需要进一步研究以确定哪些信息要素是必不可少的，制定和测试提高效率和覆盖范围的策略，并确定生存护理计划的结果是否值得在其准备和交付方面投入所需的资源。
已建议所有癌症幸存者制定 TS 和 SCP。必须确定基本要素，使方法更有效率，提高结果，进行成本效益分析，然后才能期望在生存护理方面广泛实施这一建议。
