a Department of Social Work, St. Vincent's Hospital , Melbourne , Australia.
J Psychosoc Oncol. 2014;32(4):396-412. doi: 10.1080/07347332.2014.917141.
Although the complexity of age combined with a cancer diagnosis can result in unmet supportive care needs there are seldom resources to assess or address such needs for older people with cancer (OPWC). The purpose of this project was to trial a service to improve the care for OPWC through (1) an expanded supportive care screening process and (2) capacity building of subacute ambulatory care services (SACS) staff to increase referrals to community-based rehabilitation.
METHODS/DESIGN: Collaboration between allied health (AH) staff at an inner city general hospital with a large cancer service, a cancer specialist hospital, and a SACS service in Melbourne, Australia, developed an AH geriatric screening assessment (GSA) tool. Parallel to this process training was provided to SACS staff in relation to working with OPWC. Although close to one half (44%) of SACS staff who participated in this program (n = 22) had over 6 years' experience, 32% had not worked with OPWC. Prior to training, 81% did not feel confident in their knowledge about working with this cohort. After their training 72% were more confident about normal aging and implications for care of OPWC. Of the 491 patients screened, 80% were older than age 65, however, only 25 resided in the SACS catchment area. More than one third of these did not have clear rehabilitation needs, and the remainder were not referred due to ongoing medical issues. Less than one half of the patients in the catchment area were discussed in a Multi-disciplinary Meeting (MDM) but all were referred to allied health and assessed using the GSA. Although this project did not result in referrals of OPWC to SACS the training program for SACS staff was a success and allied health assessments were improved to include GSA factors. The complexity of care for OPWC was further highlighted through interviews with staff involved with the study.
尽管年龄的复杂性加上癌症诊断可能导致老年人癌症患者（OPWC）的支持性护理需求未得到满足，但很少有资源来评估或满足此类需求。本项目的目的是通过（1）扩大支持性护理筛选流程和（2）增强亚急性门诊护理服务（SACS）人员的能力，来改善 OPWC 的护理，尝试一项服务。目的是增加向社区康复转介的机会。
方法/设计：位于澳大利亚墨尔本的一家市立综合医院的与大型癌症服务相关的联合健康（AH）工作人员、一家癌症专科医院和一家 SACS 服务之间的合作，开发了一种 AH 老年筛选评估（GSA）工具。与此同时，为 SACS 工作人员提供了与 OPWC 合作相关的培训。尽管接近一半（44%）参与该计划的 SACS 工作人员（n=22）有超过 6 年的工作经验，但 32%的人没有与 OPWC 合作过。在培训之前，81%的人对自己在这一人群中的工作知识没有信心。培训后，72%的人对正常衰老及其对 OPWC 护理的影响更有信心。在筛选的 491 名患者中，80%的人年龄大于 65 岁，但只有 25 人居住在 SACS 服务范围内。这些人中，超过三分之一没有明确的康复需求，其余的则由于持续的医疗问题没有被转介。服务范围内的患者中不到一半在多学科会议（MDM）上进行了讨论，但所有患者都被转介到联合健康服务部门，并使用 GSA 进行了评估。虽然该项目并未将 OPWC 转介到 SACS，但 SACS 工作人员的培训计划取得了成功，并且联合健康评估得到了改善，包括 GSA 因素。通过对参与研究的工作人员的采访，进一步突出了 OPWC 的护理复杂性。
