Michel Gisela, Gianinazzi Micol Eva, Vetsch Janine, Mader Luzius, Lupatsch Judith E, von der Weid Nicolas X, Rueegg Corina Silvia
Department of Health Sciences and Health Policy, University of Lucerne, Switzerland.
Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Swiss Med Wkly. 2017 Jul 13;147:w14457. doi: 10.4414/smw.2017.14457. eCollection 2017.
Regular follow-up care is essential for childhood cancer survivors, but we know little about physicians' experience with it. We aimed to describe: (1) involvement of Swiss physicians in follow-up care; (2) content of follow-up care provided; (3) problems encountered; and (4) additional resources needed.
Within this cross-sectional survey we sent adapted questionnaires via professional associations to a sample of medical oncologists (MOs), paediatric oncologists (POs), general practitioners (GPs) and paediatricians (P) in Switzerland. Only oncologists involved in follow-up care were asked to report problems. GPs and Ps not involved in follow-up could indicate why. All physicians were asked about the content of follow-up care provided and additional resources needed.
A total of 183 physicians responded (27 MO, 13 PO, 122 GP, 21 P). Involved in follow-up were 81% of MOs, 85% of POs, 39% of GPs and 81% of Ps. Follow-up content differed between oncologists (MO and PO) and generalists (GP and P), with generalists examining or informing less in regard to the former cancer. POs reported more problems than MOs: many POs reported problems with transition of survivors to adult care (91%), and because of financial resources (73%) and time restraints (73%). MOs reported most problems during transition (23%). Not being aware of a survivor was the most common reason for GPs and Ps not participating in follow-up (74%). All groups reported a need for standardised protocols (85-91%) and specialised training (55-73%). GPs (94%) and Ps (100%) additionally desired more support from oncologists.
To improve quality and efficiency of follow-up care a national follow-up care model including standardised protocols and guidelines needs to be developed.
定期随访对儿童癌症幸存者至关重要，但我们对医生在这方面的经验了解甚少。我们旨在描述：（1）瑞士医生参与随访的情况；（2）所提供随访的内容；（3）遇到的问题；以及（4）所需的额外资源。
在这项横断面调查中，我们通过专业协会向瑞士的医学肿瘤学家（MO）、儿科肿瘤学家（PO）、全科医生（GP）和儿科医生（P）样本发送了改编后的问卷。仅要求参与随访的肿瘤学家报告问题。未参与随访的GP和P可说明原因。所有医生均被问及所提供随访的内容以及所需的额外资源。
共有183名医生回复（27名MO、13名PO、122名GP、21名P）。81%的MO、85%的PO、39%的GP和81%的P参与了随访。肿瘤学家（MO和PO）与全科医生（GP和P）的随访内容有所不同，全科医生对既往癌症的检查或告知较少。PO报告的问题比MO多：许多PO报告幸存者向成人护理过渡存在问题（91%），以及因资金（73%）和时间限制（73%）。MO报告在过渡期间问题最多（23%）。不知道有幸存者是GP和P不参与随访的最常见原因（74%）。所有组均报告需要标准化方案（85 - 91%）和专业培训（55 - 73%）。GP（94%）和P（100%）还希望从肿瘤学家那里获得更多支持。
为提高随访质量和效率，需要制定包括标准化方案和指南的国家随访模式。
