Noyes Katia, Monson John R T, Rizvi Irfan, Savastano Ann, Green James S A, Sevdalis Nick
University of Rochester Medical Center; American Cancer Society, Hope Lodge, Rochester; St James Mercy Hospital, Hornell, NY; Barts Health; and Center for Implementation Science, King's College London, London, United Kingdom.
J Oncol Pract. 2016 Nov;12(11):1059-1066. doi: 10.1200/JOP.2016.013896. Epub 2016 Sep 30.
Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions.
团队合作对于应对癌症护理协调与提供过程中出现的诸多挑战至关重要,尤其是对于那些跨越地理界限、在癌症治疗过程中多次进出多个医疗系统的患者所带来的问题。癌症治疗选择和方式的不断增加、医疗行业最近采用的大量技术平台之间的不兼容性,以及提供者和系统之间相互竞争且不一致的激励措施,使得协调癌症患者护理的问题更加复杂。在此,我们通过一个真实患者的治疗过程来审视癌症区域护理协调问题。本文将综合并详细阐述关于复杂系统协调方法的现有知识,特别是在一般医疗和癌症护理多学科团队方面;定义源自组织心理学和人因研究且适用于基于团队的癌症护理提供的协调要素;并提出改善区域癌症护理提供中多学科团队协调的方法以及未来研究的方向。流动的、多系统患者这一现象在癌症护理中构成了日益严峻的挑战。矛盾的是,高质量、大规模卓越中心的发展以及利用电子病历实现虚拟通信和数据共享的便捷性,却给有效的基于团队的癌症护理带来了重大障碍。这些挑战迫切需要解决办法。