Tilburt Jon C, Kelley Stacy, DeCourtney Christine A, Humeniuk Katherine M, Latini Jerilyn, Kim Simon P
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA ; Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA ; Knowledge & Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA ; Robert D. and Patrician E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
Clinical and Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
Int J Circumpolar Health. 2014 Feb 27;73:23637. doi: 10.3402/ijch.v73.23637. eCollection 2014.
Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care.
To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors.
In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items.
Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice.
These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.
对于阿拉斯加初级保健中优化前列腺癌幸存者医疗保健的限制因素知之甚少。
描述阿拉斯加部落卫生系统（ATHS）内初级保健提供者对前列腺癌幸存者护理的经验和态度。
2011年10月下旬，我们通过电子邮件向268名ATHS初级保健提供者发送了一份包含22个项目的电子调查问卷，内容涉及对一名假设的前列腺癌幸存者进行前列腺特异性抗原（PSA）监测的频率；谁应该负责患者的终身前列腺癌监测；作为幸存者，谁应该支持患者的情感和医疗需求；以及提供者在处理复发监测、勃起功能障碍、尿失禁、雄激素剥夺治疗和情感需求方面的舒适程度。我们使用简单逻辑回归来检验提供者特征与其对幸存者调查项目的回答之间的关联。
在成功联系的221人中，共有114人回复（回复率为52%）。大多数ATHS提供者表示他们会每12个月进行一次PSA检测（69%），并认为理想情况下，假设患者的初级保健提供者应该负责其终身前列腺癌监测（60%）。大多数提供者报告说，在与前列腺癌幸存者讨论前列腺癌复发（59%）、勃起功能障碍（64%）、尿失禁（63%）和情感需求（61%）等话题时，他们感到“中等”或“非常”舒适。这些结果因提供者特征（包括性别、从业年限以及他们在实践中见到的前列腺癌幸存者数量）而有所不同。
这些数据表明，阿拉斯加的大多数初级保健提供者准备好在当地承担前列腺癌幸存者的护理工作。然而，我们也发现，相当一部分提供者对自己管理前列腺癌幸存者常见问题的能力缺乏信心，这意味着持续获得拥有更多专业知识的专家的帮助将是有益的。
