Magnuson Allison, Wallace James, Canin Beverly, Chow Selina, Dale William, Mohile Supriya G, Hamel Lauren M
University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI.
J Oncol Pract. 2016 Nov;12(11):1115-1122. doi: 10.1200/JOP.2016.013623. Epub 2016 Sep 30.
We present the case of a 92-year-old man, MH, who was given a diagnosis of colorectal cancer. His primary care physician, surgeon, geriatric oncologist, and family members all played important roles in his care. MH's case is an example of a lack of explicit shared goal setting by the health care providers with the patient and family members and how that impeded care planning and health. This case demonstrates the importance of explicitly discussing and establishing shared goals in team-based cancer care delivery early on and throughout the care process, especially for older adults. Each individual member's goals should be understood as they fit within the overarching shared team goals. We emphasize that shared goal setting and alignment of individual goals is a dynamic process that must occur several times at critical decision points throughout a patient's care continuum. Providers and researchers can use this illustrative case to consider their own work and contemplate how shared goal setting can improve patient-centered care and health outcomes in various team-based care settings. Shared goal setting among team members has been demonstrated to improve outcomes in other contexts. However, we stress, that little investigation into the impact of shared goal setting on team-based cancer care delivery has been conducted. We list immediate research goals within team-based cancer care delivery that can provide a foundation for the understanding of the process and outcomes of shared goal setting.
我们介绍了一位92岁男性MH的病例，他被诊断患有结直肠癌。他的初级保健医生、外科医生、老年肿瘤学家和家庭成员在其护理过程中都发挥了重要作用。MH的病例体现了医疗服务提供者与患者及家庭成员缺乏明确的共同目标设定，以及这如何阻碍了护理计划和健康状况。该病例表明，在基于团队的癌症护理提供过程中，尤其是对于老年人，尽早并在整个护理过程中明确讨论并确立共同目标非常重要。每个成员的目标都应在总体团队共同目标的框架内得到理解。我们强调，共同目标设定以及个人目标的协调一致是一个动态过程，在患者护理的整个连续过程中的关键决策点必须多次进行。医疗服务提供者和研究人员可以利用这个示例病例来审视自己的工作，并思考共同目标设定如何在各种基于团队的护理环境中改善以患者为中心的护理和健康结局。团队成员之间的共同目标设定已被证明在其他情况下可改善结局。然而，我们强调，对于共同目标设定对基于团队的癌症护理提供的影响，目前进行的调查很少。我们列出了基于团队的癌症护理提供中的近期研究目标，这些目标可为理解共同目标设定的过程和结局奠定基础。
