Wallner Lauren P, Li Yun, Furgal Allison K C, Friese Christopher R, Hamilton Ann S, Ward Kevin C, Jagsi Reshma, Katz Steven J, Hawley Sarah T
Lauren P. Wallner, Yun Li, Allison K.C. Furgal, Christopher R. Friese, Reshma Jagsi, Steven J. Katz, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center of Excellence in Health Services Research and Development, Ann Arbor, MI; Ann S. Hamilton, University of Southern California Keck School of Medicine, Los Angeles, CA; and Kevin C. Ward, Emory University, Atlanta, GA.
J Clin Oncol. 2017 Sep 1;35(25):2942-2948. doi: 10.1200/JCO.2017.73.1307. Epub 2017 Jul 12.
Purpose Prior studies have suggested a need for greater clarity about provider roles in team-based cancer care; however, little is known about patients' preferences regarding which providers handle their care needs after primary cancer treatment. Methods We surveyed women with newly diagnosed stages 0 to II breast cancer who were treated in 2014 and 2015 as reported to the Georgia and Los Angeles SEER registries (N = 2,372; 68% response rate). Patient preferences regarding which provider handles the following care needs after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, and comorbidity management. Associations between patient demographic factors with preferences for provider roles-oncology-directed care versus primary care provider (PCP)-directed care-were assessed by using multivariable logistic regression. Results The majority of women preferred that their PCPs handle general preventive care (79%) and comorbidity care (84%), but a notable minority of women preferred that their oncologists direct this care (21% and 16%, respectively). Minority women-black and Asian versus white-and women with a high school education or less-versus undergraduate college education or more-displayed greater odds of preferring oncology-directed care-versus PCP-directed care-for their general preventive care (black odds ratio [OR], 2.01; 95% CI, 1.43 to 2.82; Asian OR, 1.74; 95% CI, 1.13 to 2.69; high school education or less OR, 1.51; 95% CI, 1.10 to 2.08). Similar variations existed for comorbidity care. Conclusion In this sample, minority women and those with less education more often preferred that oncologists direct certain aspects of their care after breast cancer treatment that are normally delivered by a PCP. Efforts to clarify provider roles in survivorship care to patients may be effective in improving team-based cancer care.
目的 先前的研究表明,在基于团队的癌症护理中,需要更明确提供者的角色;然而,对于原发性癌症治疗后由哪些提供者来满足患者的护理需求,患者的偏好却知之甚少。方法 我们对2014年和2015年在佐治亚州和洛杉矶监测、流行病学和最终结果(SEER)登记处报告接受治疗的新诊断为0至II期乳腺癌的女性进行了调查(N = 2372;回复率68%)。确定了患者对于治疗后由哪些提供者满足以下护理需求的偏好:后续乳房X光检查、其他癌症筛查、一般预防性护理和合并症管理。通过多变量逻辑回归评估患者人口统计学因素与提供者角色偏好(肿瘤学指导护理与初级保健提供者(PCP)指导护理)之间的关联。结果 大多数女性希望其初级保健提供者负责一般预防性护理(79%)和合并症护理(84%),但有相当少数女性希望其肿瘤学家指导此类护理(分别为21%和16%)。少数族裔女性(黑人、亚洲人与白人相比)以及高中及以下学历女性(与本科及以上学历女性相比)在一般预防性护理方面更倾向于肿瘤学指导护理而非初级保健提供者指导护理的可能性更高(黑人优势比[OR],2.01;95%置信区间[CI],1.43至2.82;亚洲人OR,1.74;95%CI,1.13至2.69;高中及以下学历OR,1.51;95%CI,1.10至2.08)。合并症护理方面也存在类似差异。结论 在该样本中,少数族裔女性和受教育程度较低的女性更常希望肿瘤学家在乳腺癌治疗后指导某些通常由初级保健提供者提供的护理方面。向患者阐明幸存者护理中提供者角色的努力可能有助于改善基于团队的癌症护理。