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贯彻落实:美国癌症项目中生存护理计划使用的一致性

Following through: the consistency of survivorship care plan use in United States cancer programs.

作者信息

Birken Sarah A, Deal Allison M, Mayer Deborah K, Weiner Bryan J

机构信息

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 1107A McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA,

出版信息

J Cancer Educ. 2014 Dec;29(4):689-97. doi: 10.1007/s13187-014-0628-8.

Abstract

The Institute of Medicine suggests that consistent survivorship care plan (SCP) use involves developing and delivering SCPs to all cancer survivors and their primary care providers (PCPs). We describe the consistency of SCP use in US cancer programs and assess its relationship with cancer-program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs reporting current SCP use (n = 36, 81 % response rate). We operationalized consistent SCP use as whether SCPs were (1) developed for ≥75 % survivors, (2) delivered to ≥75 % survivors, (3) delivered to ≥75 % PCPs, and (4) all of the above. We use descriptive statistics to report SCP use consistency and evaluate associations using Fisher's exact and Wilcoxon rank sum tests. SCPs were developed for ≥75 % survivors in five programs (15 %), eight (25 %) delivered ≥75 % SCPs to survivors, seven (23 %) delivered ≥75 % SCPs to PCPs, and only one program (4 %) met all three criteria. We found relationships between SCP use consistency and geographic region (p = .05), initiating SCP use in response to survivors' requests (p = .03), and membership in the National Cancer Institute's National Community Cancer Centers Program (p = .01). SCP use is highly inconsistent. Survivors and cancer care quality improvement organizations may play a key role in improving the consistency of SCP use in US cancer programs. Survivors can initiate SCP use. Cancer care quality improvement organizations can specify how cancer programs' compliance with SCP guidelines will be assessed. Future research should identify mechanisms underlying the relationships that we found.

摘要

美国医学研究所建议,持续使用癌症幸存者护理计划(SCP)包括为所有癌症幸存者及其初级保健提供者(PCP)制定并提供SCP。我们描述了美国癌症项目中SCP使用的一致性,并评估其与癌症项目层面决定因素的关系。我们对了解癌症项目中幸存者护理实践且报告当前使用SCP情况的员工进行了调查(n = 36,回复率81%)。我们将持续使用SCP定义为SCP是否:(1)为≥75%的幸存者制定;(2)提供给≥75%的幸存者;(3)提供给≥75%的初级保健提供者;以及(4)满足以上所有条件。我们使用描述性统计来报告SCP使用的一致性,并使用Fisher精确检验和Wilcoxon秩和检验来评估相关性。在五个项目(15%)中,SCP是为≥75%的幸存者制定的;八个项目(25%)向≥75%的幸存者提供了SCP;七个项目(23%)向≥75%的初级保健提供者提供了SCP;只有一个项目(4%)满足所有三个标准。我们发现SCP使用的一致性与地理区域(p = 0.05)、应幸存者要求启动SCP使用(p = 0.03)以及成为美国国立癌症研究所的国家社区癌症中心项目成员(p = 0.01)之间存在关联。SCP的使用高度不一致。幸存者和癌症护理质量改进组织可能在提高美国癌症项目中SCP使用的一致性方面发挥关键作用。幸存者可以启动SCP的使用。癌症护理质量改进组织可以明确如何评估癌症项目对SCP指南的遵守情况。未来的研究应该确定我们所发现关系背后的机制。

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