使用退伍军人事务医疗系统的结直肠癌幸存者的慢性病管理观点:一项定性分析。
Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis.
作者信息
Zullig Leah L, Goldstein Karen M, Bosworth Hayden B, Andrews Sara M, Danus Susanne, Jackson George L, Provenzale Dawn, Weinberger Morris, Kelley Michael J, Voils Corrine I
机构信息
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
Department of Population Health Sciences, Duke University Medical Center, Durham, USA.
出版信息
BMC Health Serv Res. 2018 Mar 9;18(1):171. doi: 10.1186/s12913-018-2975-3.
BACKGROUND
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases.
METHODS
We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded.
RESULTS
The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers.
CONCLUSIONS
Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.
背景
结直肠癌(CRC)是美国第三大常见诊断癌症。CRC幸存者可能有复杂的医疗保健需求,需要专科医生和初级保健医生的共同护理。我们的目标是了解CRC幸存者如何看待他们的生存护理,尤其是他们心血管相关慢性病的管理。
方法
我们确定了2007年10月1日至2015年12月31日期间在北卡罗来纳州或弗吉尼亚州的退伍军人事务医疗中心被诊断为非转移性CRC的患者。2016年,我们进行了基于电话的半结构化访谈,以评估幸存者的癌症生存经历和健康优先事项的变化。访谈持续进行直至达到主题饱和。访谈进行了录音、转录和编码。
结果
25名参与者的平均年龄为64岁,在访谈时距离CRC诊断约4年;大多数是白人(60%)、男性(92%),并且被诊断为结肠癌(64%)而非直肠癌。CRC幸存者报告:(1)关注点从癌症生存转移到降低心血管疾病风险(例如通过控制体重);(2)在服用心血管疾病相关药物方面存在挑战;(3)对与初级保健提供者接触的重要性有了新的认识。
结论
癌症经历塑造了幸存者对自身健康的看法。心血管相关慢性病的管理对退伍军人CRC幸存者很重要。需要为CRC幸存者提供量身定制的降低心血管疾病风险计划。