涉及全科医生和癌症专科医生的癌症患者共享护理随机对照试验。
Randomized Controlled Trial of Shared Care for Patients With Cancer Involving General Practitioners and Cancer Specialists.
作者信息
Johnson Claire E, Saunders Christobel M, Phillips Michael, Emery Jon D, Nowak Anna K, Overheu Kate, Ward Alison M, Joske David J L
机构信息
The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom
The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
出版信息
J Oncol Pract. 2015 Sep;11(5):349-55. doi: 10.1200/JOP.2014.001569. Epub 2015 Mar 10.
PURPOSE
We aimed to determine whether a shared care model (SCM) during chemotherapy treatment improved emotional well-being, empowerment, and prevalence of symptoms for people being treated for cancer.
METHODS
People receiving chemotherapy for hematologic, breast, ovarian, or colorectal malignancies at two cancer centers were randomly assigned to receive SCM or standard care. The SCM involved a patient-held record, a project coordinator, routine contact between the patient and general practitioner/primary care physician, and primary care physician education. Participants completed the Hospital Anxiety and Depression Scale, the Mini-Mental Adjustment to Cancer, and an empowerment questionnaire before, in the middle of, and on completion of chemotherapy. The presence and severity of adverse effects of chemotherapy were recorded by patients in a symptom diary.
RESULTS
Ninety-seven eligible participants were randomly allocated, less than half the intended recruitment. There were no significant differences between the groups for empowerment, symptom prevalence, or Mini-Mental Adjustment to Cancer scores. The proportion with clinical anxiety (Hospital Anxiety and Depression Scale anxiety score of ≥ 11) decreased over time in both groups (P = .013) but decreased more in the intervention group (P = .002). Depression was unchanged over time.
CONCLUSION
Our study was limited by low recruitment and predominance of patients with breast cancer, and was underpowered for the main analyses. Results should therefore be interpreted with caution. Little benefit was seen for SCM in the majority of domains including empowerment, symptom prevalence, and psychological adjustment to cancer. The SCM showed efficacy in clinically anxious patients. Such interventions may be better implemented by using a targeted approach to identify at-need subgroups.
目的
我们旨在确定化疗期间的共享护理模式（SCM）是否能改善癌症患者的情绪健康、自主感以及症状发生率。
方法
在两个癌症中心接受血液学、乳腺癌、卵巢癌或结直肠癌化疗的患者被随机分配接受SCM或标准护理。SCM包括患者持有的记录、项目协调员、患者与全科医生/初级保健医生之间的常规联系以及对初级保健医生的培训。参与者在化疗前、化疗中期和化疗结束时完成医院焦虑抑郁量表、癌症心理适应简易量表以及一份自主感问卷。患者在症状日记中记录化疗不良反应的存在情况和严重程度。
结果
97名符合条件的参与者被随机分配，不到预期招募人数的一半。两组在自主感、症状发生率或癌症心理适应简易量表得分方面没有显著差异。两组中临床焦虑（医院焦虑抑郁量表焦虑得分≥11）的比例均随时间下降（P = 0.013），但干预组下降得更多（P = 0.002）。抑郁情况随时间没有变化。
结论
我们的研究受到招募人数少和乳腺癌患者占主导的限制，主要分析的效能不足。因此，对结果的解释应谨慎。在包括自主感、症状发生率和癌症心理适应等大多数领域，SCM几乎没有益处。SCM在临床焦虑患者中显示出疗效。此类干预措施可能通过采用针对性方法识别有需求的亚组来更好地实施。
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