癌症护理中对二次诊断服务的态度：韩国肿瘤学家的全国性调查。

Attitudes towards second opinion services in cancer care: a nationwide survey of oncologists in Korea.

作者信息

Shin Dong Wook, Cho Juhee, Yang Hyung Kook, Kim So Young, Mok Hyung Kyun, Lee Hyejin, Park Seon Mee, Huh Jung Sik, Ryu Junsun, Park Jong Hyock

机构信息

Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.

Department of Health, Behavior and Society & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA Cancer Education Center, Samsung Comprehensive Cancer Center, SAHIST and School of Medicine, Sunkyungkwan University School of Medicine, Seoul.

出版信息

Jpn J Clin Oncol. 2016 May;46(5):441-7. doi: 10.1093/jjco/hyw016. Epub 2016 Mar 22.

DOI:10.1093/jjco/hyw016

PMID:27004900

Abstract

OBJECTIVE

Second opinion is a common phenomenon in many health systems, especially in the care of patients with cancer. However, it is not clear whether second opinion seeking should be promoted or discouraged and how second opinion services and policies can be better formalized to maximize the benefits and minimize the disadvantages.

METHODS

A nationwide survey was conducted with a representative sample of 678 physicians involved in cancer care (75.5% participation rate) recruited in 13 cancer centres.

RESULTS

Most physicians involved with cancer care perceived patients' second opinion seeking as a legitimate right (96.0%) and they acknowledged the need for second opinion services under certain conditions (98.2%). Many believed that second opinions can enhance patient satisfaction (77.3%) and quality of care (74.3%), but they also had concerns about increase in healthcare and societal costs (91.3%) and concentration in a high-volume centre (90.7%). While the majority agreed with the involvement of the first opinion physicians in the second opinion services (69.5%), there were mixed opinions regarding the desirability of remote (teleconsultation) second opinion services (49.0%) and coverage by national health insurance (51.9%).

CONCLUSION

Physicians were generally positive to second opinion services and expected positive consequences in terms of patient satisfaction and quality of care. However, they had concerns about the consequences regarding cost and equity, and disagreements were observed regarding the way to improve second opinion services. The physicians' opinions revealed in our study will be helpful in developing clearer guidelines used to maximize the benefits of second opinion services.

摘要

目的

二次诊疗意见在许多医疗体系中是一种常见现象，尤其是在癌症患者的护理中。然而，尚不清楚寻求二次诊疗意见是应得到鼓励还是抑制，以及如何能更好地规范二次诊疗意见服务及政策，以实现利益最大化和弊端最小化。

方法

对来自13个癌症中心的678名参与癌症护理的医生进行了具有代表性的全国性调查（参与率为75.5%）。

结果

大多数参与癌症护理的医生认为患者寻求二次诊疗意见是一项合法权利（96.0%），并且他们承认在某些情况下需要二次诊疗意见服务（98.2%）。许多人认为二次诊疗意见可以提高患者满意度（77.3%）和护理质量（74.3%），但他们也担心医疗保健和社会成本的增加（91.3%）以及集中在少数高诊疗量的中心（90.7%）。虽然大多数人同意首诊医生参与二次诊疗意见服务（69.5%），但对于远程（电话会诊）二次诊疗意见服务的可取性（49.0%）和国家医疗保险覆盖范围（51.9%）存在不同意见。