Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, 650 Charles Young Drive South, Los Angeles, CA 90095-6900, USA.
J Cancer Surviv. 2013 Sep;7(3):323-30. doi: 10.1007/s11764-013-0269-7. Epub 2013 Mar 15.
The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening, and treatment. This qualitative research examines provider perceptions and expectations of posttreatment breast cancer care across five network sites with the goal of better understanding provider behavior during the posttreatment phase of the cancer care trajectory.
Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of posttreatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software.
There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of posttreatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery.
These results identify a need for increased focus on care coordination during the posttreatment phase of breast cancer care within the University of California system and the potential for system and provider-level interventions that could help increase coordination of posttreatment care.
Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the posttreatment phase and lays a foundation for targeted interventions to increase adherence to evidence-based recommendations.
雅典娜乳腺健康网络合作是加利福尼亚大学系统范围内的一个项目，旨在推动乳腺癌预防、筛查和治疗方面的创新。这项定性研究考察了五个网络站点的提供者对乳腺癌治疗后护理的看法和期望，目的是更好地了解提供者在癌症护理轨迹的治疗后阶段的行为。
每个站点的调查人员都对肿瘤专家和初级保健提供者（PCP）进行了半结构化访谈。访谈使用了案例研究示例和关于提供乳腺癌治疗后护理的开放式和封闭式问题。访谈员手动记录受访者的反馈，将其汇编到数据库中，然后使用 NVivo 9 软件进行编码和分析。
共有 39 名关键信息提供者来自各个站点：14 名肿瘤内科医生、7 名放射肿瘤学家、11 名外科医生、3 名肿瘤护士和 4 名 PCP。在访谈中，协调护理是一个主要的非提示主题。人们认为需要在机构之间进行更多的协调，以改善治疗后医疗服务的提供，并且需要在肿瘤学领域进行更多的协调，特别是为了避免随访护理和服务的重复。参与者期望进行频繁的随访访问，并将生物标志物测试和先进的成像服务用作常规监测护理的一部分。实施生存护理计划被认为是改善护理提供的一种方式。
这些结果确定了在加利福尼亚大学系统内乳腺癌治疗后阶段需要更加关注协调护理，并且有可能进行系统和提供者层面的干预，以帮助增加治疗后护理的协调。
乳腺癌幸存者并不总是接受基于证据的护理。这项研究有助于更好地了解在治疗后阶段是什么促使提供者的行为，并为增加对基于证据的建议的依从性的针对性干预奠定基础。
