将英国的癌症专科手术服务集中化：调查对患者、护理人员和医疗保健专业人员重要的因素。
Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals.
机构信息
Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
出版信息
BMC Cancer. 2018 Feb 27;18(1):226. doi: 10.1186/s12885-018-4137-8.
BACKGROUND
The centralisation of specialist cancer surgical services across London Cancer and Greater Manchester Cancer, England, may significantly change how patients experience care. These centres are changing specialist surgical pathways for several cancers including prostate, bladder, kidney, and oesophago-gastric cancers, increasing the specialisation of centres and providing surgery in fewer hospitals. While there are potential benefits related to centralising services, changes of this kind are often controversial. The aim of this study was to identify factors related to the centralisation of specialist surgical services that are important to patients, carers and health care professionals.
METHODS
This was a questionnaire-based study involving a convenience sample of patient and public involvement (PPI) and cancer health care professional (HCP) sub-groups in London and Greater Manchester (n = 186). Participants were asked to identify which of a list of factors potentially influenced by the centralisation of specialist cancer surgery were important to them and to rank these in order of importance. We ranked and shortlisted the most important factors.
RESULTS
We obtained 52 responses (28% response rate). The factors across both groups rated most important were: highly trained staff; likelihood and severity of complications; waiting time for cancer surgery; and access to staff members from various disciplines with specialised skills in cancer. These factors were also ranked as being important separately by the PPI and HCP sub-groups. There was considerable heterogeneity in the relative ordering of factors within sub-groups and overall.
CONCLUSIONS
This study examines and ranks factors important to patients and carers, and health care professionals in order to inform the implementation of centralisation of specialist cancer surgical services. The most important factors were similar in the two stakeholder sub-groups. Planners should consider the impact of reorganising services on these factors, and disseminate this information to patients, the public and health care professionals when deciding whether or not and how to centralise specialist cancer surgical services.
背景
英格兰伦敦癌症和大曼彻斯特癌症的专科癌症外科服务集中化可能会极大地改变患者的就医体验。这些中心正在改变包括前列腺癌、膀胱癌、肾癌和食管癌在内的几种癌症的专科外科治疗途径，增加了中心的专业化程度，并减少了手术医院的数量。虽然集中服务有潜在的好处，但这种改变往往存在争议。本研究的目的是确定与专科外科服务集中化相关的、对患者、护理人员和医疗保健专业人员重要的因素。
方法
这是一项基于问卷调查的研究，涉及伦敦和大曼彻斯特的患者和公众参与（PPI）和癌症医疗保健专业人员（HCP）亚组的便利样本（n=186）。参与者被要求确定清单中列出的哪些因素可能受到专科癌症手术集中化的影响，并对这些因素进行重要性排序。我们对这些因素进行了排名和筛选。
结果
我们共获得了 52 份回复（28%的回复率）。两组参与者都认为最重要的因素是：训练有素的员工；并发症的可能性和严重程度；癌症手术的等待时间；以及能够接触到具有癌症专业技能的各个学科的员工。这两个亚组也分别对这些因素进行了重要性排序。在亚组和总体中，因素的相对排序存在相当大的差异。
结论
本研究考察并对患者、护理人员和医疗保健专业人员认为重要的因素进行了排序，以了解专科癌症外科服务集中化的实施情况。这两个利益相关者亚组中最重要的因素是相似的。规划者在决定是否以及如何集中化专科癌症外科服务时，应考虑服务重组对这些因素的影响，并将这些信息传达给患者、公众和医疗保健专业人员。
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