Kilsdonk Melvin J, Siesling Sabine, Otter Rene, van Harten Wim H
Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
School for Management and Governance/department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
Cancer Med. 2016 Mar;5(3):478-85. doi: 10.1002/cam4.612. Epub 2015 Dec 29.
External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile.
1994年，荷兰的综合医院引入了外部同行评审，以评估和改进癌症护理中的多学科团队方法。本文旨在探讨外部同行评审在癌症护理中的价值、感知到的影响以及（未来）作用。对来自15家综合医院的临床医生、肿瘤护士和管理人员进行了半结构化访谈，这些医院在16年的时间里参与了三轮同行评审。受访者对外部同行评审的目标和期望、经验、感知到的影响以及未来作用进行了反思。对访谈记录进行编码以发现反复出现的主题。改善临床护理和组织是参与的主要动机。人们认为外部同行评审对护理的多个方面产生了积极影响，如共同责任、癌症护理的内部优先级、沟通的改善以及癌症护理在综合医院中的明确结构和地位。事实证明，要在外部同行评审与组织或临床影响之间建立直接关系是困难的。三轮评审后，有人批评该项目的内容过于理论化且以组织为重点。大多数利益相关者认为，外部同行评审可以改善癌症护理中的多学科团队合作；然而，人们认为付出与明显的临床影响之间的不平衡威胁到了对它的接受度。需要更精简、更以临床为重点的项目，以使反复的同行评审保持挑战性和价值。
