Klabunde C N, Haggstrom D, Kahn K L, Gray S W, Kim B, Liu B, Eisenstein J, Keating N L
Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
Eur J Cancer Care (Engl). 2017 Jul;26(4). doi: 10.1111/ecc.12628. Epub 2017 Jan 10.
Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.
癌症治疗后的护理往往零散且质量欠佳。我们探究了可能影响癌症幸存者治疗后护理协调的因素,包括肿瘤学家使用电子邮件和综合电子健康记录(EHRs)等电子技术与初级保健医生(PCPs)进行沟通的情况。我们使用了2012 - 2013年在美国一项关于癌症护理提供与结果的大型研究中,对照顾患者的医学肿瘤学家进行的一项调查数据(357名受访者;参与率52.9%)。肿瘤学家报告了他们与初级保健医生沟通的频率和方式,以及在提供治疗后护理方面的作用。75%的人表示他们就所有/大多数患者的治疗后状况和护理建议直接与初级保健医生进行沟通。在那些直接与初级保健医生沟通的人中,70%总是/通常使用书面通信,而36%总是/通常使用综合电子健康记录;电话和电子邮件的使用较少。80%的人报告至少共同管理过一项治疗后的一般医疗护理需求。在多变量调整分析中,沟通方式和强度均与共同管理幸存者的护理无关。肿瘤学家依赖书面通信与初级保健医生沟通可能是护理协调的一个障碍。我们讨论了加强肿瘤学家与初级保健医生之间沟通与护理协调以及更好地满足癌症幸存者治疗后需求的新研究方向