National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
J Clin Oncol. 2012 Aug 10;30(23):2897-905. doi: 10.1200/JCO.2011.39.9832. Epub 2012 Jul 9.
Addressing psychosocial needs, including key components of psychologic distress, physical symptoms, and health promotion, is vital to cancer follow-up care. Yet little is known about who provides psychosocial care. This study examined physician-reported practices regarding care of post-treatment cancer survivors. We sought to characterize physicians who reported broad involvement in (ie, across key components of care) and shared responsibility for psychosocial care.
A nationally representative sample of medical oncologists (n = 1,130) and primary care physicians (PCPs; n = 1,021) were surveyed regarding follow-up care of breast and colon cancer survivors.
Approximately half of oncologists and PCPs (52%) reported broad involvement in psychosocial care. Oncologist and PCP confidence, beliefs about who is able to provide psychosocial support, and preferences for shared responsibility for care predicted broad involvement. However, oncologists' and PCPs' perceptions of who provides specific aspects of psychosocial care differed (P < .001); both groups saw themselves as the main providers. Oncologists' confidence, PCPs' beliefs about who is able to provide psychosocial support, and oncologist and PCP preference for models other than shared care were inversely associated with a shared approach to care.
Findings that some providers are not broadly involved in psychosocial care and that oncologists and PCPs differ in their beliefs regarding who provides specific aspects of care underscore the need for better care coordination, informed by the respective skills and desires of physicians, to ensure needs are met. Interventions targeting physician confidence, beliefs about who is able to provide psychosocial support, and preferred models for survivorship care may improve psychosocial care delivery.
满足癌症患者的社会心理需求，包括心理困扰、身体症状和健康促进等关键组成部分，对于癌症随访护理至关重要。然而，对于谁来提供社会心理护理，我们知之甚少。本研究考察了医生报告的治疗后癌症幸存者护理实践。我们旨在描述报告广泛参与（即护理的关键组成部分）和共同承担社会心理护理责任的医生。
对 1130 名肿瘤内科医生和 1021 名初级保健医生进行了一项全国代表性样本调查，内容涉及乳腺癌和结肠癌幸存者的随访护理。
约一半的肿瘤内科医生和初级保健医生（52%）报告广泛参与社会心理护理。医生的信心、对谁能够提供社会心理支持的信念以及对护理共同责任的偏好预测了广泛的参与。然而，肿瘤内科医生和初级保健医生对谁提供特定方面的社会心理护理的看法存在差异（P<0.001）；两者都认为自己是主要提供者。肿瘤内科医生的信心、初级保健医生对谁能够提供社会心理支持的信念，以及肿瘤内科医生和初级保健医生对非共同护理模式的偏好与共同护理方法呈反比。
一些提供者没有广泛参与社会心理护理，而且肿瘤内科医生和初级保健医生在谁提供特定护理方面的看法存在差异，这突显了需要更好的护理协调，要根据医生的各自技能和意愿来提供护理，以确保满足患者的需求。针对医生信心、谁能够提供社会心理支持的信念以及生存护理偏好模型的干预措施可能会改善社会心理护理的提供。
