Nguyen Timothy K, Bauman Glenn S, Watling Christopher J, Hahn Karin
Division of Radiation Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada.
Department of Clinical Neurological Sciences and Oncology, Western University, London, ON, Canada.
Support Care Cancer. 2017 Jan;25(1):213-219. doi: 10.1007/s00520-016-3414-9. Epub 2016 Sep 11.
Increasingly, patient- and family-centered care (PFCC) is recognized as a valuable component of healthcare reform with rich opportunities for improvement within oncology. Shifting toward PFCC requires physician buy-in; however, research examining their perspectives on PFCC is lacking. We sought to explore oncologists' perspectives on PFCC to identify factors that influence their ability to practice PFCC.
We conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using thematic analysis and principles drawn from grounded theory. Subsequently, focus groups consisting of the interviewed participants were facilitated to confirm and elaborate on our findings. Constant comparisons were used to identify recurring themes.
Three dominant themes emerged. First, physicians displayed cautious engagement in their approach to PFCC. Collectively, participants understood the general principles of PFCC. However, there was a limited understanding of the value, implications, and motivation for improving PFCC which may create reluctance with physician buy-in. Second, both individual and system barriers to practicing PFCC were identified. A lack of physician acknowledgement and engagement and competing responsibilities emerged as provider-level challenges. System barriers included impaired clinic workflow, physical infrastructure constraints, and delays in access to care. Third, physicians were able to identify existing and potential PFCC behaviors that were feasible within existing system constraints.
Advancing PFCC will require continued physician education regarding the value of PFCC, acknowledgement and preservation of effective patient- and family-centered strategies, and creative solutions to address the system constraints to delivering PFCC.
患者及家庭为中心的护理（PFCC）日益被视为医疗改革的重要组成部分，在肿瘤学领域有丰富的改进机会。向PFCC转变需要医生的认同；然而，缺乏关于他们对PFCC看法的研究。我们试图探讨肿瘤学家对PFCC的看法，以确定影响他们实施PFCC能力的因素。
我们在一家加拿大的学术癌症机构对18名肿瘤学家（8名放疗科医生、4名内科医生、4名外科医生、2名血液肿瘤学家）进行了半结构化访谈。访谈数据采用主题分析和扎根理论的原则进行分析。随后，组织了由受访参与者组成的焦点小组，以确认并详细阐述我们的研究结果。采用持续比较法来识别反复出现的主题。
出现了三个主要主题。首先，医生在对待PFCC的方式上表现出谨慎的参与度。总体而言，参与者理解PFCC的一般原则。然而，对改进PFCC的价值、影响和动机的理解有限，这可能导致医生不愿认同。其次，确定了实施PFCC的个人和系统障碍。医生缺乏认可和参与以及相互竞争的职责成为提供者层面的挑战。系统障碍包括门诊工作流程受损、物理基础设施限制以及获得护理的延迟。第三，医生能够识别在现有系统限制内可行的现有和潜在的PFCC行为。
推进PFCC将需要持续对医生进行关于PFCC价值的教育，认可并保留有效的以患者及家庭为中心的策略，以及创造性地解决实施PFCC的系统限制问题。
