Grimison Peter, Phillips Fiona, Butow Phyllis, White Kate, Yip Desmond, Sardelic Frank, Underhill Craig, Tse Regina, Simes Robyn, Turley Kim, Raymond Carmel, Goldstein David
Sydney Cancer Centre, Camperdown, NSW, Australia.
Asia Pac J Clin Oncol. 2013 Sep;9(3):226-38. doi: 10.1111/ajco.12014. Epub 2012 Sep 18.
Survival rates for patients with cancer who live in rural and regional areas are worse than in metropolitan areas. This may be due to geographical isolation, delayed diagnosis, inadequate transport, lower socioeconomic status and workforce shortages. We conducted a qualitative study of rural patients, carers and health professionals. It aimed to identify concerns about, and strategies to optimize cancer care from those with direct experience.
Focus groups and structured interviews were conducted in New South Wales, Australia at four rural and regional hospitals (Bega, Dubbo, Tamworth and Albury) and three metropolitan locations (in Sydney and the Jean Colvin Hostel) caring for rural patients. Sessions were audiotaped, transcribed and analyzed using thematic analysis.
In total, 36 patients, 14 carers and 32 health professionals were interviewed in seven focus groups and 42 individual interviews. Concerns related to access to oncologists and other health professionals, and for services for investigation and treatment, the financial and social consequences of travel, unmet carer support needs and the hardships for health professionals. Strategies for improvement included comprehensive staffing and services coordinated in a hub and spoke model from adjacent larger centers, adequate reimbursement for travel and better carer support.
We identified broad concerns about regional and rural cancer care in Australia. The Australian Federal Government commitment of $560 million to establish regional cancer centers is welcome; however, improvements must extend beyond infrastructure funding in large regional centers to comprehensive staffing in centers currently lacking resident oncologists, travel support and assistance for carers.
生活在农村和偏远地区的癌症患者的生存率低于大城市地区的患者。这可能是由于地理隔离、诊断延迟、交通不便、社会经济地位较低以及劳动力短缺。我们对农村患者、护理人员和卫生专业人员进行了一项定性研究。其目的是从有直接经验的人员中确定对癌症护理的担忧以及优化癌症护理的策略。
在澳大利亚新南威尔士州的四家农村和地区医院（贝加、杜博、塔姆沃思和奥尔伯里）以及三个大城市地点（悉尼和让·科尔文旅馆）对农村患者进行护理的机构中，开展了焦点小组讨论和结构化访谈。会议进行了录音、转录，并使用主题分析法进行分析。
总共在七个焦点小组和42次个人访谈中采访了36名患者、14名护理人员和32名卫生专业人员。担忧涉及到获得肿瘤学家和其他卫生专业人员的服务、调查和治疗服务、旅行的经济和社会后果、护理人员未得到满足的支持需求以及卫生专业人员面临的困难。改进策略包括通过相邻较大中心的中心辐射模式协调全面的人员配备和服务、给予足够的旅行报销以及更好地支持护理人员。
我们确定了澳大利亚农村和偏远地区癌症护理方面的广泛担忧。澳大利亚联邦政府承诺拨款5.6亿澳元建立地区癌症中心，这是值得欢迎的；然而，改进必须超越大型地区中心的基础设施资金，扩展到目前缺乏常驻肿瘤学家的中心的全面人员配备、旅行支持和对护理人员的援助。
