UNSW Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, UNSW, Sydney, Australia.
BMC Fam Pract. 2013 Aug 26;14:124. doi: 10.1186/1471-2296-14-124.
Outcomes for colorectal cancer patients vary significantly. Compared to other countries, Australia has a good record with patient outcomes, yet there is little information available on the referral pathway. This paper explores the views of Australian patients and their experiences of referral for colorectal cancer treatment following diagnosis; the aim was to improve our understanding of the referral pathway and guide the development of future interventions.
A purposive sampling strategy was used, recruiting 29 patients representing urban and rural areas from 3 Australian states who participated in 4 focus groups. Seven patients provided individual interviews to supplement the data. Recordings were transcribed verbatim, data was coded with NVivo software and analysed thematically before deductive analysis.
Four aspects of the referral process were identified by patients, namely detection/diagnosis, referral for initial treatment/specialist care, the roles of the GP/specialist, and the patient's perceived involvement in the process. The referral process was characterised by a lack of patient involvement, with few examples of shared decision-making and few examples of limited choice. However, patients did not always feel they had the knowledge to make informed decisions. Information exchange was highly valued by patients when it occurred, and it increased their satisfaction with the process. Other factors mediating care included the use of the public versus private health system, the quality of information exchange (GP to specialist and GP to patient), continuity of care between GP and specialist, and the extent of information provision when patients moved between specialist and GP care.
Patients described poor GP continuity, ad hoc organisational systems and limited information exchange, at both interpersonal and inter-organisational levels, all leading to sub-optimal care. Implementation of a system of information feedback to GPs and engagement with them might improve information exchange for patients, enabling them to be more involved in improved referral outcomes.
结直肠癌患者的治疗效果存在显著差异。相较于其他国家，澳大利亚在患者治疗效果方面表现良好，但关于其转诊途径的信息却很少。本文旨在通过探讨澳大利亚患者在确诊后接受结直肠癌治疗的转诊体验和看法，了解其转诊途径，为未来的干预措施提供指导。
采用目的抽样法，从澳大利亚 3 个州的城市和农村地区招募了 29 名患者，他们参加了 4 个焦点小组，其中 7 名患者接受了单独访谈以补充数据。对访谈录音进行逐字转录，用 NVivo 软件对数据进行编码，然后进行主题分析和演绎分析。
患者提出了转诊过程的 4 个方面，分别是发现/诊断、初始治疗/专科治疗转诊、全科医生/专科医生的角色，以及患者对过程的参与度。转诊过程的特点是缺乏患者参与，很少有共享决策的例子，也很少有选择受限的例子。然而，患者并不总是觉得自己有能力做出明智的决策。当信息交流发生时，患者非常重视，这增加了他们对过程的满意度。其他影响治疗的因素包括使用公共或私人医疗系统、医患之间以及医医之间信息交流的质量、全科医生和专科医生之间的护理连续性，以及患者在专科医生和全科医生之间转移时提供的信息量。
患者描述了全科医生连续性差、组织系统随意、信息交流有限，这些都导致了护理效果不佳。实施向全科医生反馈信息的系统并与他们合作，可能会改善患者的信息交流，使他们能够更积极地参与改善转诊结果。
