妇科肿瘤学家对影响转诊至门诊专科姑息治疗的看法。
Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care.
作者信息
Hay Casey M, Lefkowits Carolyn, Crowley-Matoka Megan, Bakitas Marie A, Clark Leslie H, Duska Linda R, Urban Renata R, Chen Lee-May, Creasy Stephanie L, Schenker Yael
机构信息
*Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA; †Division of Gynecologic Oncology and ‡Palliative Care, Department of Medicine, University of Colorado Denver, Denver, CO; §Medical Education/Medical Humanities and Bioethics/Anthropology, Northwestern University, Chicago, IL; ∥Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL; ¶Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC; #Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA; **Division of Gynecologic Oncology, University of Washington, Seattle, WA; ††University of California Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; and ‡‡Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health; and §§Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
出版信息
Int J Gynecol Cancer. 2017 Mar;27(3):588-596. doi: 10.1097/IGC.0000000000000893.
OBJECTIVE
Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement.
METHODS/MATERIALS: We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes.
RESULTS
Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics.
CONCLUSIONS
Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.
目的
晚期妇科恶性肿瘤患者很少接受早期专科姑息治疗。我们试图了解妇科肿瘤学家的观点如何影响门诊专科姑息治疗的转诊，以帮助制定改进策略。
方法/材料：我们在6家美国国立癌症研究所指定的癌症中心开展了一项定性访谈研究，这些中心都设有完善的门诊姑息治疗服务。2015年9月至2016年3月期间，34名妇科肿瘤学家参与了半结构化电话访谈，访谈重点围绕与门诊专科姑息治疗相关的态度、经历和偏好。一个多学科团队采用持续比较法分析访谈记录，以归纳方式制定编码框架。通过反复的分析过程，对编码进行分类、分组并提炼成主题。
结果
参与者的平均（标准差）年龄为47（10）岁。访谈的平均（标准差）时长为25（7）分钟。关于妇科肿瘤学家如何看待门诊专科姑息治疗，出现了三个主要主题：（1）与患者的长期关系是妇科肿瘤学的一个独特且决定性的方面，会影响转诊；（2）妇科肿瘤学家重视姑息治疗临床医生的沟通技巧和第三方视角，以提高预后意识，并帮助协调患者偏好与医生建议之间的差异；（3）妇科肿瘤学家更喜欢将专科姑息治疗服务纳入妇科肿瘤诊所。
结论
妇科肿瘤学家重视与患者的长期关系，并利用专科姑息治疗来协调围绕预后意识或治疗方案的冲突。将专科姑息治疗纳入妇科肿瘤诊所可能会促进临床医生之间的沟通，并便于妇科肿瘤学家在整个病程中参与其中。
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