Department of Family Medicine, University of Manitoba, 2038-675 McDermot Avenue, Winnipeg, MB, Canada R3E 0V9.
J Cancer Surviv. 2012 Dec;6(4):468-75. doi: 10.1007/s11764-012-0235-9. Epub 2012 Oct 10.
This study examines at a population level how colorectal cancer (CRC) survivors evaluate the continuity and quality of their follow-up care after treatment, particularly for those in the care of a primary care provider (PCP).
A survey was mailed in 2010 to all individuals in Manitoba, Canada diagnosed in 2008/2009 with stage II and III CRC. Respondents were asked to identify the main provider(s) of their follow-up care. Those indicating a PCP completed the Patient Continuity of Care Questionnaire (PCCQ), which assesses continuity of care upon discharge from hospital to community. Quality of life (QOL) on the Functional Assessment of Cancer Therapy--Colorectal (FACT-C) and the Illness Intrusiveness Rating Scale was collected as well as demographic information. Descriptive statistics and regression analyses were utilized.
The response rate was 246/360 or 68.3 %. Most participants were Caucasian with a mean age of 70 and 18 months from diagnosis. A single "main provider" of follow-up care was named by 47 %, most frequently a FP or oncologist, but a majority (53 %) indicated multiple providers. Twenty-four combinations of providers were described. The 106 respondents (43.1 %) who named a PCP as a main provider completed the PCCQ and reported high scores on its five subscales. In multivariate analysis, lower FACT-C QOL scores (OR 2.72, CI 1.12-6.57) and male gender (OR 2.82, CI 1.11-7.18) predicted poorer evaluations of continuity of care. Concern was highest regarding sexual function, body image, fatigue, impact on work and recreation, and bowel control, and in those who were younger or with rectal cancer.
The organization of CRC follow-up care between providers is complex and variable, but patients followed by PCPs evaluate their transitions of care after treatment favorably. Specific clinical issues and higher risk groups are identified and may benefit from specific attention from all providers.
Most CRC survivors are satisfied when their primary care provider becomes responsible for follow-up care. However, this is less true for those who are having more challenges in recovery. These survivors should ensure that information transfer and support services are identified that will smooth this transition.
本研究从人群层面上调查了结直肠癌（CRC）幸存者在治疗后对其随访护理连续性和质量的评价，特别是针对那些由初级保健提供者（PCP）提供护理的患者。
2010 年，我们向 2008/2009 年在加拿大马尼托巴省被诊断为 II 期和 III 期 CRC 的所有患者邮寄了一份调查问卷。受访者被要求确定其随访护理的主要提供者。那些表示有 PCP 的人完成了患者连续性护理问卷（PCCQ），该问卷评估了从医院到社区出院时的护理连续性。还收集了生活质量（QOL），采用癌症治疗功能评估-结直肠癌（FACT-C）和疾病侵扰评分量表，以及人口统计学信息。采用描述性统计和回归分析。
应答率为 246/360 或 68.3%。大多数参与者为白种人，平均年龄为 70 岁，距诊断时间为 18 个月。有 47%的患者指定了一名单一的“主要提供者”，最常见的是家庭医生或肿瘤学家，但大多数（53%）患者表示有多名提供者。共描述了 24 种提供者组合。106 名（43.1%）指定 PCP 为主要提供者的受访者完成了 PCCQ，并报告了其五个子量表的高分。在多变量分析中，FACT-C QOL 评分较低（OR 2.72，CI 1.12-6.57）和男性（OR 2.82，CI 1.11-7.18）预测连续性护理评价较差。患者最关注的是性功能、身体形象、疲劳、对工作和娱乐的影响以及肠道控制，以及年龄较小或患有直肠癌的患者。
CRC 随访护理提供者之间的组织是复杂和多变的，但由 PCP 随访的患者对其治疗后护理的过渡评价较好。确定了具体的临床问题和高风险群体，所有提供者都可以从中受益。
大多数 CRC 幸存者对其初级保健提供者负责随访护理感到满意。然而，对于那些在康复过程中面临更多挑战的患者来说，情况并非如此。这些幸存者应确保确定信息传递和支持服务，以顺利过渡。
