Mathews Maria, Bulman Donna, Ryan Dana
Affiliations: Division of Community Health and Humanities (Mathews, Ryan), Faculty of Medicine, Health Sciences Centre, Memorial University, St. John's, NL; Faculty of Nursing (Bulman), University of New Brunswick, Fredericton, NB.
CMAJ Open. 2017 Oct 17;5(4):E773-E778. doi: 10.9778/cmajo.20170039.
There is growing interest in the role of physician as health advocate; however, few studies have documented advocacy from the patient's perspective. To address this gap, we examined the experiences of patients with cancer from the onset of symptoms to the start of treatment in Newfoundland and Labrador and aimed to describe wait times and efforts to improve timeliness of care from the patients' perspective.
We conducted qualitative interviews with 60 participants aged 19 years or more with breast, colorectal, lung or prostate cancer who were recruited from a survey of patients with cancer that was carried out as an earlier part of a larger study. All survey participants had received care at regional cancer clinics in Newfoundland and Labrador and were selected by means of purposive sampling based on their type of cancer, level of satisfaction with care and place of residence (urban, semiurban or rural). Interviews were transcribed verbatim and coded by means of a thematic approach.
Participants described actions taken by themselves, their families/friends or members of their health care team to reduce their wait for a diagnosis and/or treatment. In all instances, participants believed that these actions resulted in more timely care. Participants reported that "insider knowledge" of health care professionals (whether friends, family members or members of the care team) was particularly valuable in reducing delays.
The use of advocacy was relatively commonplace. The role of advocacy, whether it originates from patient or caregiver, is important to ensure access to timely, good-quality cancer care.
人们对医生作为健康倡导者的角色越来越感兴趣；然而，很少有研究从患者的角度记录倡导情况。为了填补这一空白，我们调查了纽芬兰和拉布拉多省癌症患者从出现症状到开始治疗的经历，旨在从患者的角度描述等待时间以及为提高医疗及时性所做的努力。
我们对60名年龄在19岁及以上的乳腺癌、结直肠癌、肺癌或前列腺癌患者进行了定性访谈，这些患者是从一项癌症患者调查中招募的，该调查是一项更大规模研究的早期部分。所有调查参与者都在纽芬兰和拉布拉多省的地区癌症诊所接受过治疗，并根据他们的癌症类型、对治疗的满意度和居住地（城市、半城市或农村）通过目的抽样进行选择。访谈内容逐字记录，并采用主题方法进行编码。
参与者描述了他们自己、家人/朋友或医疗团队成员为减少诊断和/或治疗等待时间所采取的行动。在所有情况下，参与者都认为这些行动使治疗更加及时。参与者报告说，医疗专业人员（无论是朋友、家庭成员还是护理团队成员）的“内部消息”在减少延误方面特别有价值。
倡导的使用相对普遍。倡导的作用，无论其源自患者还是护理人员，对于确保获得及时、高质量的癌症治疗都很重要。
