Department of Health Policy and Management, Emory University, Atlanta, GA 30329, USA.
J Clin Oncol. 2013 Jun 20;31(18):2322-36. doi: 10.1200/JCO.2012.45.6954. Epub 2013 May 20.
High-quality, well-coordinated cancer survivorship care is needed yet barriers remain owing to fragmentation in the United States health care system. This article is a nationwide survey of barriers perceived by primary care physicians (PCPs) and medical oncologists (MOs) regarding breast and colorectal cancer survivorship care beyond 5 years after treatment.
The Survey of Physician Attitudes Regarding the Care of Cancer Survivors was mailed out in 2009 to a nationally-representative sample (n = 3,596) of US PCPs and MOs. Ten physician-perceived cancer survivorship care barriers/concerns were compared between the two provider types. Using weighted multinomial logistic regression, we modeled each barrier, adjusting for physician demographics, reimbursement, training, and practice characteristics.
We received responses from 2,202 physicians (1,072 PCPs; 1,130 MOs; 65.1% cooperation rate). In adjusted patient-related barriers models, MOs were more likely than PCPs to report patient language barriers (odds ratio, [OR], 1.72; 95% CI, 1.22 to 2.42), insurance restrictions impeding test/treatment use (OR, 1.42; 95% CI, 1.03 to 1.96), and patients requesting more aggressive testing (OR, 4.08; 95% CI, 2.73 to 6.10). In adjusted physician-related barriers models, PCPs were more likely to report inadequate training (OR, 3.06; 95% CI, 2.03 to 4.61) and ordering additional tests/treatments because of malpractice concerns (OR, 1.87; 95% CI, 1.20 to 2.93). MOs were more likely to report uncertainty regarding general preventive care responsibility (often/always: OR, 1.97; 95% CI, 1.13 to 3.43; sometimes: OR, 2.16; 95% CI, 1.60 to 2.93).
MOs and PCPs perceive different cancer follow-up care barriers/concerns to be problematic. Resolving inadequate training, malpractice-driven test ordering, and preventive-care responsibility concerns may require continuing education, explicit guidelines, and survivorship care plans. Reviewing care plans with survivors may also reduce patients' requests for unnecessary testing.
高质量、协调良好的癌症生存者护理是必要的，但由于美国医疗保健系统的碎片化，仍然存在障碍。本文是对初级保健医生（PCP）和肿瘤医生（MO）在治疗后 5 年以上对乳腺癌和结直肠癌生存者护理的看法进行的全国性调查，调查了他们认为存在的障碍。
2009 年，向美国全国代表性样本（n=3596）的 PCP 和 MO 医生邮寄了《医生对癌症生存者护理态度调查》。比较了两种类型的提供者之间的 10 种医生感知的癌症生存者护理障碍/关注点。使用加权多项逻辑回归，我们对每个障碍进行建模，调整了医生的人口统计学、报销、培训和实践特征。
我们收到了 2202 名医生的回复（1072 名 PCP；1130 名 MO；65.1%的合作率）。在调整后的患者相关障碍模型中，与 PCP 相比，MO 更有可能报告患者的语言障碍（优势比[OR]，1.72；95%置信区间[CI]，1.22 至 2.42）、保险限制阻碍了测试/治疗的使用（OR，1.42；95%CI，1.03 至 1.96）以及患者要求更积极的检查（OR，4.08；95%CI，2.73 至 6.10）。在调整后的医生相关障碍模型中，PCP 更有可能报告培训不足（OR，3.06；95%CI，2.03 至 4.61）和由于医疗事故担忧而开出额外的检查/治疗（OR，1.87；95%CI，1.20 至 2.93）。MO 更有可能报告对一般预防保健责任的不确定性（经常/总是：OR，1.97；95%CI，1.13 至 3.43；有时：OR，2.16；95%CI，1.60 至 2.93）。
MO 和 PCP 认为不同的癌症随访护理障碍/关注点存在问题。解决培训不足、因医疗事故而进行的检查/治疗订单以及预防保健责任问题可能需要继续教育、明确的指导方针和生存者护理计划。与生存者一起审查护理计划也可以减少患者对不必要检查的要求。
