比较基于网络的由医疗服务提供者发起和患者发起的癌症患者生存护理计划：一项随机对照试验。
Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial.
作者信息
Smith Katherine Clegg, Tolbert Elliott, Hannum Susan M, Radhakrishnan Archana, Zorn Kelsey, Blackford Amanda, Greco Stephen, Smith Karen, Snyder Claire F
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States.
出版信息
JMIR Cancer. 2016 Aug 30;2(2):e12. doi: 10.2196/cancer.5947.
BACKGROUND
Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake.
OBJECTIVE
This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated.
METHODS
This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs-both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors' Unmet Needs (CaSUN) surveys at baseline and 2 months.
RESULTS
A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors' Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs' value.
CONCLUSIONS
Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs-regardless of the SCP form used.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK).
背景
生存护理计划（SCPs）旨在促进患者、肿瘤学家和初级保健提供者之间的沟通与协调。大多数SCP计划都侧重于肿瘤学提供者启动SCP流程，但时间和资源障碍限制了其采用率。
目的
本试验比较两种基于网络的SCP工具的可行性和价值：由提供者启动与由患者启动。
方法
这项混合方法研究从两家学术附属社区肿瘤学机构招募临床医生。符合条件的患者由参与研究的肿瘤学家进行治疗，患有非转移性癌症，在入组前≤2个月完成了急性治疗，且没有疾病证据。患者按1:1随机分配到由提供者启动或由患者启动的SCP组——两者均为基于网络的工具。我们在基线和随访时对提供者进行了定性访谈，并在入组2个月后对患者进行了访谈。此外，在基线和2个月时对患者进行了“为（新）幸存者的生活做准备”（PLANS）和“癌症幸存者未满足的需求”（CaSUN）调查。
结果
共邀请了40名提供者参与研究，其中13名（33%）入组。提供者或诊所工作人员需要研究人员协助识别符合条件的患者；41名患者被随机分组，其中25名完成了随访（61%；13名由提供者启动，12名由患者启动）。在这25名患者中，11名（44%）启动了SCP；5名（20%）将SCP提供给了他们的初级保健提供者。在“为（新）幸存者的生活做准备”和“癌症幸存者未满足的需求”调查中，两组患者往往报告知识水平高、信心足且未满足的需求少。在定性访谈中，提供者和患者讨论了SCP的价值。
结论
无论模板是由患者还是由提供者启动，以及这些工具基于网络的设计如何，生存护理计划的障碍仍然存在。应进一步努力强调识别和完成SCP的工作流程功能——无论使用何种SCP形式。
试验注册
ClinicalTrials.gov NCT02405819；https://clinicaltrials.gov/ct2/show/NCT02405819（由WebCite存档于http://www.webcitation.org/6jWqcWOvK）。
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