Iyer Neel S, Mitchell Hannah-Rose, Zheng Daniel J, Ross Wilhelmenia L, Kadan-Lottick Nina S
Lake Erie College of Osteopathic Medicine, 1858 W. Grandview Blvd, Erie, PA, 16509, USA.
Department of Psychology, University of Miami, PO Box 248185-0751, Coral Gables, FL, 33124, USA.
Support Care Cancer. 2017 May;25(5):1547-1555. doi: 10.1007/s00520-016-3544-0. Epub 2017 Jan 3.
Focusing on primary care providers (PCPs) of known childhood cancer survivors, we used a mixed methods approach to understand providers' experiences with the survivorship care plan (SCP), as well as preferences and barriers regarding survivorship care.
The SCP was sent to 202 eligible PCPs of patients attending a regional survivorship clinic. The PCPs then completed quantitative postal surveys. Sixteen PCPs underwent an additional qualitative interview. Provider characteristics were examined as potential predictors of experiences, preferences, and barriers regarding survivorship care. Grounded theory was utilized to analyze the qualitative data.
Respondents (n=134) included 55% pediatricians, 23% internists, 20% family practitioners, and 2% obstetricians/gynecologists. Only 8% of PCPs preferred to have primary responsibility for survivorship care; 46% favored a specialized clinic. A minority of PCPs reported that they felt "very comfortable" using the SCP to guide surveillance (31%) or deliver all survivorship care (3%). Endorsed barriers included lack of knowledge/training (74%), not recalling or understanding the contents of the SCP (69%), and uncertainty about who is responsible for providing care (58%). Two distinct themes emerged from the qualitative interviews: a preference not to be responsible for survivorship care, and uncertain utility of the SCP.
Our study suggests that PCPs of childhood cancer survivors generally felt uncomfortable using the SCP and providing survivorship care. Even with the availability of the SCP, the biggest barrier was lack of knowledge. Our data suggests that including PCPs in survivorship care will require additional educational opportunities and evaluation of more collaborative models of care delivery.
以已知的儿童癌症幸存者的初级保健提供者（PCP）为重点，我们采用混合方法来了解提供者在生存护理计划（SCP）方面的经历，以及在生存护理方面的偏好和障碍。
将SCP发送给在区域生存诊所就诊患者的202名符合条件的PCP。这些PCP随后完成了定量邮寄调查。16名PCP接受了额外的定性访谈。将提供者特征作为生存护理方面的经历、偏好和障碍的潜在预测因素进行研究。运用扎根理论分析定性数据。
受访者（n = 134）包括55%的儿科医生、23%的内科医生、20%的家庭医生和2%的妇产科医生。只有8%的PCP倾向于对生存护理承担主要责任；46%倾向于设立专门诊所。少数PCP报告称，他们对使用SCP来指导监测（31%）或提供所有生存护理（3%）“非常放心”。认可的障碍包括知识/培训不足（74%）、不记得或不理解SCP的内容（69%）以及对谁负责提供护理存在不确定性（58%）。定性访谈中出现了两个不同的主题：不愿对生存护理负责，以及SCP的效用不确定。
我们的研究表明，儿童癌症幸存者的PCP在使用SCP和提供生存护理方面普遍感到不放心。即使有SCP，最大的障碍也是知识不足。我们的数据表明，让PCP参与生存护理将需要额外的教育机会，并评估更多协作式护理模式。
