Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
Department of Surgery, Dalhousie University, Halifax, Canada.
J Cancer Surviv. 2018 Aug;12(4):495-508. doi: 10.1007/s11764-018-0688-6. Epub 2018 Mar 23.
The purpose of this study was to compare outcomes assessed in extant randomized controlled trials (RCTs) to outcomes that stakeholders expect from survivorship care plans (SCPs). To facilitate the transition from active treatment to follow-up care for the 15.5 million US cancer survivors, many organizations require SCP use. However, results of several RCTs of SCPs' effectiveness have been null, possibly because they have evaluated outcomes on which SCPs should be expected to have limited influence. Stakeholders (e.g., survivors, oncologists) may expect outcomes that differ from RCTs' outcomes.
We identified RCTs' outcomes using a PubMed literature review. We identified outcomes that stakeholders expect from SCPs using semistructured interviews with stakeholders in three healthcare systems in the USA and Canada. Finally, we mapped RCTs' outcomes onto stakeholder-identified outcomes.
RCT outcomes did not fully address outcomes that stakeholders expected from SCPs, and RCTs assessed outcomes that stakeholders did not expect from SCPs. RCTs often assessed outcomes only from survivors' perspectives.
RCTs of SCPs' effectiveness have not assessed outcomes that stakeholders expect. To better understand SCPs' effectiveness, future RCTs should assess outcomes of SCP use that are relevant from the perspective of multiple stakeholders.
SCPs' effectiveness may be optimized when used with an eye toward outcomes that stakeholders expect from SCPs. For survivors, this means using SCPs as a map to guide them with respect to what kind of follow-up care they should seek, when they should seek it, and from whom they should seek it.
本研究旨在比较现有随机对照试验（RCT）评估的结果与利益相关者对生存护理计划（SCP）的预期结果。为了促进 1550 万美国癌症幸存者从积极治疗向随访护理的过渡，许多组织都要求使用 SCP。然而，几项 SCP 有效性 RCT 的结果均为无效，这可能是因为它们评估了 SCP 应该具有有限影响的结果。利益相关者（例如，幸存者、肿瘤学家）可能期望的结果与 RCT 的结果不同。
我们通过 PubMed 文献回顾确定了 RCT 的结果。我们通过在美国和加拿大的三个医疗保健系统与利益相关者进行半结构化访谈，确定了利益相关者对 SCP 的预期结果。最后，我们将 RCT 的结果映射到利益相关者确定的结果上。
RCT 结果并未完全解决利益相关者对 SCP 的预期结果，而且 RCT 评估了利益相关者对 SCP 不期望的结果。RCT 通常仅从幸存者的角度评估结果。
SCP 有效性的 RCT 并未评估利益相关者期望的结果。为了更好地了解 SCP 的有效性，未来的 RCT 应评估从多个利益相关者的角度来看与 SCP 使用相关的结果。
当使用 SCP 时，关注利益相关者对 SCP 的期望结果，可以优化 SCP 的有效性。对于幸存者而言，这意味着使用 SCP 作为指导他们应该寻求何种随访护理、何时寻求以及应该向谁寻求的地图。
