Day Sophie, Coombes R Charles, McGrath-Lone Louise, Schoenborn Claudia, Ward Helen
Patient Experience Research Centre, School of Public Health, Imperial College London, UK.
Department of Anthropology, Goldsmiths, London, UK.
Sociol Health Illn. 2017 Jan;39(1):143-158. doi: 10.1111/1467-9566.12457. Epub 2016 Jul 27.
We conducted ethnographic research in collaboration with a large, research-intensive London breast cancer service in 2013-2014 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision-making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already-complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.
2013年至2014年，我们与伦敦一家大型研究密集型乳腺癌服务机构合作开展了人种志研究，以了解分层医学的实践及潜在影响。分层医学常被视为个性化医疗和精准医疗的同义词，但我们发现，这三个术语也涉及治疗与护理的不同方面。个性化医疗是2016年英国国家医疗服务体系（NHS）英格兰战略中采用的术语，在该战略中，乳腺癌护理被视为提高生物学精准度和改善患者治疗效果的典型例子。我们探讨了这种基于生物学的分层医学如何影响更广泛的护理与治疗关系。我们正式采访了33名患者及其23名护理人员，包括医护人员；参加了与服务改进、医疗决策、公众参与和科学发展相关的会议，并在候诊室、临床会诊及其他场所跟踪观察患者。我们发现，基于生物学研究的新方案的实施给本已复杂的患者就医流程带来了更多并发症。新旧分层形式的结合几乎对所有患者、护理人员和工作人员都产生了影响，导致护理体验往往感觉更缺乏而非更具个性化。
