Tseng Yolanda D, Krishnan Monica S, Jones Joshua A, Sullivan Adam J, Gorman Daniel, Taylor Allison, Pacold Michael, Kalinowski Barbara, Mamon Harvey J, Abrahm Janet, Balboni Tracy A
Harvard Radiation Oncology Program, Boston, Massachusetts.
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
Pract Radiat Oncol. 2014 Jul-Aug;4(4):247-53. doi: 10.1016/j.prro.2013.09.005. Epub 2013 Nov 20.
The American Society of Clinical Oncology has recommended tailoring palliative cancer care (PCC) to the distinct and complex needs of advanced cancer patients. The Supportive and Palliative Radiation Oncology (SPRO) service was initiated July 2011 to provide dedicated palliative radiation oncology (RO) care to cancer patients. We used care providers' ratings to assess SPRO's impact on the quality of PCC and compared perceptions of PCC delivery among physicians practicing with and without a dedicated palliative RO service.
An online survey was sent to 117 RO care providers working at 4 Boston-area academic centers. Physicians and nurses at the SPRO-affiliated center rated the impact of the SPRO service on 8 PCC quality measures (7-point scale, "very unfavorably" to "very favorably"). Physicians at all sites rated their department's performance on 10 measures of PCC (7-point scale, "very poorly" to "very well").
Among 102 RO care providers who responded (response rate, 89% for physicians; 83% for nurses), large majorities believed that SPRO improved the following PCC quality measures: overall quality of care (physician/nurse, 98%/92%); communication with patients and families (95%/96%); staff experience (93%/84%); time spent on technical aspects of PCC (eg, reviewing imaging) (88%/56%); appropriateness of treatment recommendations (85%/84%); appropriateness of dose/fractionation (78%/60%); and patient follow-up (64%/68%). Compared with physicians practicing in departments without a dedicated palliative RO service, physicians at the SPRO-affiliated department rated the overall quality of their department's PCC more highly (P = .02).
Clinicians indicated that SPRO improved the quality of PCC. Physicians practicing within this dedicated service rated their department's overall PCC quality higher than physicians practicing at academic centers without a dedicated service. These findings point to dedicated palliative RO services as a promising means of improving PCC quality.
美国临床肿瘤学会建议根据晚期癌症患者独特而复杂的需求来调整姑息性癌症护理（PCC）。支持性和姑息性放射肿瘤学（SPRO）服务于2011年7月启动，旨在为癌症患者提供专门的姑息性放射肿瘤学（RO）护理。我们使用护理提供者的评分来评估SPRO对PCC质量的影响，并比较了有和没有专门姑息性RO服务的医生对PCC提供情况的看法。
向在波士顿地区4个学术中心工作的117名RO护理提供者发送了在线调查问卷。SPRO附属中心的医生和护士对SPRO服务对8项PCC质量指标的影响进行评分（7分制，从“非常不利”到“非常有利”）。所有站点的医生对其科室在10项PCC指标上的表现进行评分（7分制，从“非常差”到“非常好”）。
在102名回复的RO护理提供者中（医生的回复率为89%；护士的回复率为83%），绝大多数人认为SPRO改善了以下PCC质量指标：总体护理质量（医生/护士，98%/92%）；与患者及其家属的沟通（95%/96%）；工作人员经验（93%/84%）；在PCC技术方面花费的时间（例如，查看影像）（88%/56%）；治疗建议的适宜性（85%/84%）；剂量/分割的适宜性（78%/60%）；以及患者随访（64%/68%）。与没有专门姑息性RO服务的科室的医生相比，SPRO附属科室的医生对其科室PCC的总体质量评价更高（P = 0.02）。
临床医生表示SPRO提高了PCC的质量。在这项专门服务中执业的医生对其科室PCC的总体质量评价高于在没有专门服务的学术中心执业的医生。这些发现表明专门的姑息性RO服务是提高PCC质量的一种有前景的手段。
