Berg Carla, Stratton Erin, Esiashvili Natia, Mertens Ann, Vanderpool Robin C
Emory University, Georgia, USA.
University of Kentucky, Lexington, KY, USA.
J Cancer Educ. 2016 Mar;31(1):31-8. doi: 10.1007/s13187-015-0848-6.
We examined healthcare providers' perceptions of the goals of survivorship care and survivor programs, systems-level barriers and individual patient-level barriers to engaging patients in survivorship care, and potential resources for increasing engagement. In 2012, we recruited 21 healthcare providers of young adult survivors of childhood cancers from a children's hospital and a cancer center in the Southeastern USA to complete telephone-based semi-structured interviews. The sample was 45.95 years old (SD = 7.57) on average, 52.4 % female, and 81.0 % MDs. The major goals of survivorship programs identified were medical care management (e.g., addressing late and long-term effects, providing survivorship care plans (SCPs), assisting in transition of care) and holistic care including addressing psychosocial issues and promoting healthy lifestyles. Systems-level barriers to engagement in survivorship care included limited resources (e.g., time), role confusion (e.g., within cancer centers, from treatment team to survivorship care, role of primary care providers), communication challenges within the medical system (e.g., limited tracking of patients, lack of understanding of the role of survivorship clinic), communication challenges with patients (e.g., setting expectations regarding transition to survivorship care), and lack of insurance coverage. Perceived patient-level factors included psychological barriers (e.g., fear, avoidance), resistance to survivorship care, and physical barriers (e.g., distance from survivorship clinics). Resources to address these barriers included increased access to information, technology-based resources, and ensuring valuable services. There are several systems-level and patient-level barriers to survivorship care, thus requiring multilevel interventions to promote engagement in care among young adult survivors of childhood cancer.
我们考察了医疗服务提供者对于癌症幸存者护理目标及幸存者项目的看法、在让患者参与癌症幸存者护理方面的系统层面障碍和个体患者层面障碍,以及提高参与度的潜在资源。2012年,我们从美国东南部的一家儿童医院和一家癌症中心招募了21名负责儿童癌症成年幸存者的医疗服务提供者,以完成基于电话的半结构化访谈。样本平均年龄为45.95岁(标准差=7.57),52.4%为女性,81.0%拥有医学博士学位。所确定的幸存者项目的主要目标包括医疗管理(如处理晚期和长期影响、提供幸存者护理计划(SCP)、协助护理过渡)以及整体护理,包括解决心理社会问题和促进健康生活方式。参与癌症幸存者护理的系统层面障碍包括资源有限(如时间)、角色混乱(如在癌症中心内,从治疗团队到幸存者护理,初级护理提供者的角色)、医疗系统内的沟通挑战(如对患者的跟踪有限、对幸存者诊所角色的理解不足)、与患者的沟通挑战(如设定向幸存者护理过渡的期望)以及缺乏保险覆盖。感知到的患者层面因素包括心理障碍(如恐惧、回避)、对幸存者护理的抵触以及身体障碍(如距离幸存者诊所较远)。解决这些障碍的资源包括增加信息获取、基于技术的资源以及确保提供有价值的服务。癌症幸存者护理存在若干系统层面和患者层面的障碍,因此需要多层次干预措施来促进儿童癌症成年幸存者参与护理。