Browall Maria, Forsberg Christina, Wengström Yvonne
School of Health and Education, University of Skövde, Skövde, Sweden.
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
J Clin Nurs. 2017 Jul;26(13-14):1770-1786. doi: 10.1111/jocn.13496. Epub 2017 Mar 20.
To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost-effectiveness.
As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients' satisfaction with the model of physician-led follow-up.
Systematic review.
Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005-2013. The quality of appraisal assessment was inspired by the GRADE system.
The results show that there are many different instruments used when evaluating nurse-led follow-up, which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses, and the results are hard to interpret.
Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients' information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness.
Results from well-conducted evaluation studies of nurse-led services based on theory are needed so that relevant interventions can be implemented in clinical practice. There is a need to in future studies include cost-effectiveness analyses to compare nurse-led services with other types of follow-up.
探讨如何评估在乳腺癌护理中采用护士主导的随访干预措施，重点关注患者结局和成本效益。
作为乳腺护理进展的一部分，护士主导的随访越来越多地被用作门诊常规医院随访的替代方式。有证据表明患者似乎对护士主导的随访感到满意，但缺乏证据表明这种认知是否等同于患者对医生主导的随访模式的满意度。
系统评价。
检索了三个数据库，初步筛选出29项随机对照试验。最后，对13篇文章进行了严格评价。检索的文章发表于2005年至2013年之间。评价评估的质量受到GRADE系统的启发。
结果表明，在评估护士主导的随访时使用了许多不同的工具，这使得研究之间难以比较。其中几项研究将生活质量作为结局指标；这是一个宽泛的概念，包括从社会角色、心理社会问题到症状等几个方面，因此难以用作结局指标。只有两项研究进行了任何成本效益分析，且结果难以解读。
护士主导的随访有可能带来更好的护理连续性，并提供更多时间来提供心理社会支持和满足患者的信息需求。然而，在能够根据生存、复发、患者福祉和成本效益评估与医生主导的随访等效性之前，还需要进行更多精心设计的研究。
需要基于理论的护士主导服务的精心评估研究结果，以便在临床实践中实施相关干预措施。未来的研究有必要纳入成本效益分析，以比较护士主导的服务与其他类型的随访。
