Smith Katherine C, Coa Kisha I, Klassen Ann C
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
SAGE Open Med. 2016 Sep 1;4:2050312116665935. doi: 10.1177/2050312116665935. eCollection 2016.
Improvements in cancer detection and treatment create a need for care that prioritizes acute treatment and ongoing needs. There have been calls to include health promotion in cancer care, but little empirical consideration of the work involved in such an expansion of services. In this article, we adopt a constructionist position to explore clinicians' perspectives on capacity for health promotion, specifically dietary counseling.
Our data result from 33 semi-structured qualitative interviews with members of cancer care teams. All interviewees were affiliated with one of two contrasting medical systems located in Baltimore, MD, USA. Interviews focused on professional roles and responsibilities around health promotion for cancer survivors. We employed both purposive and snowball sampling. We conducted a thematic analysis informed by the sociology of professions literature of discussions of dietary change by provider type.
We discuss four emergent themes that relate to the work of providing dietary counseling: (1) prioritization of behavior change in survivorship care, (2) evidence base for dietary messaging, (3) available time and clinical priorities and (4) clinical expertise. Interviewees generally expressed support for the importance of diet for healthy cancer survivorship. However, while there was broad support for dietary change and health promotion, we found little evidence of an emerging consensus on how this work should be accomplished, nor an indication of any occupational group expanding their professional remit to prioritize health promotion tasks.
Health promotion is the key to any efficient and effective model of cancer care. Careful attention to the impact of the task on key patient outcomes as well as system capacity for the provision of dietary counseling and its fit with a specific professional remit will be critical for successful integration of health promotion into routine cancer care.
癌症检测与治疗方面的进步使得人们需要优先考虑急性治疗及后续需求的护理。有人呼吁将健康促进纳入癌症护理，但对于服务如此扩展所涉及的工作，实证性的考量却很少。在本文中，我们采用建构主义立场，探讨临床医生对健康促进能力的看法，特别是饮食咨询方面。
我们的数据来自对癌症护理团队成员进行的33次半结构化定性访谈。所有受访者都隶属于美国马里兰州巴尔的摩市两个形成对比的医疗系统之一。访谈聚焦于癌症幸存者健康促进方面的专业角色与职责。我们采用了目的抽样和滚雪球抽样。我们依据职业社会学文献，对按提供者类型划分的饮食改变讨论进行了主题分析。
我们讨论了与提供饮食咨询工作相关的四个新出现的主题：（1）生存护理中行为改变的优先级，（2）饮食信息的证据基础，（3）可用时间和临床优先级，以及（4）临床专业知识。受访者普遍表示支持饮食对癌症幸存者健康的重要性。然而，虽然对饮食改变和健康促进有广泛支持，但我们几乎没有发现关于如何完成这项工作形成新共识的证据，也没有迹象表明任何职业群体扩大其专业职责以优先处理健康促进任务。
健康促进是任何高效且有效的癌症护理模式的关键。仔细关注该任务对关键患者结果的影响，以及提供饮食咨询的系统能力及其与特定专业职责的契合度，对于成功将健康促进纳入常规癌症护理至关重要。
