医生在癌症幸存者癌症相关后续护理中的角色。

Physician roles in the cancer-related follow-up care of cancer survivors.

作者信息

Klabunde Carrie N, Han Paul K J, Earle Craig C, Smith Tenbroeck, Ayanian John Z, Lee Richard, Ambs Anita, Rowland Julia H, Potosky Arnold L

机构信息

Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.

出版信息

Fam Med. 2013 Jul-Aug;45(7):463-74.

DOI:
Abstract

BACKGROUND AND OBJECTIVES

Information about primary care physicians' (PCPs) and oncologists' involvement in cancer-related follow-up care, and care coordination practices, is lacking but essential to improving cancer survivors' care. This study assesses PCPs' and oncologists' self-reported roles in providing cancer-related follow-up care for survivors who are within 5 years of completing cancer treatment.

METHODS

In 2009, the National Cancer Institute and the American Cancer Society conducted a nationally representative survey of PCPs (n=1,014) and medical oncologists (n=1,125) (response rate=57.6%, cooperation rate=65.1%). Mailed questionnaires obtained information on physicians' roles in providing cancer-related follow-up care to early-stage breast and colon cancer survivors, personal and practice characteristics, beliefs about and preferences for follow-up care, and care coordination practices.

RESULTS

More than 50% of PCPs reported providing cancer-related follow-up care for survivors, mainly by co-managing with an oncologist. In contrast, more than 70% of oncologists reported fulfilling these roles by providing the care themselves. In adjusted analyses, PCP co-management was associated with specialty, training in late or long-term effects of cancer, higher cancer patient volume, favorable attitudes about PCP care involvement, preference for a shared model of survivorship care, and receipt of treatment summaries from oncologists. Among oncologists, only preference for a shared care model was associated with co-management with PCPs.

CONCLUSIONS

PCPs and oncologists differ in their involvement in cancer-related follow-up care of survivors, with co-management more often reported by PCPs than by oncologists. Given anticipated national shortages of PCPs and oncologists, study results suggest that improved communication and coordination between these providers is needed to ensure optimal delivery of follow-up care to cancer survivors.

摘要

背景与目的

关于初级保健医生(PCP)和肿瘤学家参与癌症相关后续护理以及护理协调实践的信息匮乏,但对于改善癌症幸存者的护理至关重要。本研究评估了初级保健医生和肿瘤学家在为完成癌症治疗5年内的幸存者提供癌症相关后续护理方面自我报告的角色。

方法

2009年,美国国立癌症研究所和美国癌症协会对初级保健医生(n = 1014)和医学肿瘤学家(n = 1125)进行了一项具有全国代表性的调查(回复率 = 57.6%,合作率 = 65.1%)。通过邮寄问卷获取了医生在为早期乳腺癌和结肠癌幸存者提供癌症相关后续护理方面的角色、个人及执业特征、对后续护理的看法和偏好以及护理协调实践等信息。

结果

超过50%的初级保健医生报告为幸存者提供癌症相关后续护理,主要方式是与肿瘤学家共同管理。相比之下,超过70%的肿瘤学家报告通过自己提供护理来履行这些职责。在调整分析中,初级保健医生的共同管理与专业、癌症晚期或长期影响方面的培训、更高的癌症患者数量、对初级保健医生参与护理的积极态度、对共同生存护理模式的偏好以及从肿瘤学家处收到治疗总结有关。在肿瘤学家中,只有对共同护理模式的偏好与与初级保健医生的共同管理有关。

结论

初级保健医生和肿瘤学家在参与癌症幸存者的癌症相关后续护理方面存在差异,初级保健医生比肿瘤学家更常报告共同管理。鉴于预计全国范围内初级保健医生和肿瘤学家短缺,研究结果表明需要改善这些提供者之间的沟通与协调,以确保为癌症幸存者提供最佳的后续护理。

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