给癌症幸存者的生活方式建议：一项关于健康专业人员观点的定性研究
Lifestyle advice to cancer survivors: a qualitative study on the perspectives of health professionals.
作者信息
Koutoukidis Dimitrios A, Lopes Sonia, Fisher Abigail, Williams Kate, Croker Helen, Beeken Rebecca J
机构信息
Department of Behavioural Science and Health, University College London, London, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
出版信息
BMJ Open. 2018 Mar 27;8(3):e020313. doi: 10.1136/bmjopen-2017-020313.
OBJECTIVES
Adoption of healthy lifestyle behaviours has shown promising effectiveness in reducing the high morbidity burden of cancer survivors. Health professionals (HPs) are well suited to provide lifestyle advice but few survivors report receiving guidance from them. This study aimed to explore HPs' perspective of lifestyle advice (on healthy eating, physical activity, smoking, and alcohol) for cancer survivors.
DESIGN
In-depth semistructured qualitative interviews were conducted by telephone or face to face. Data were analysed using qualitative content analysis.
SETTING AND PARTICIPANTS
Twenty-one UK HPs working in secondary care with breast, prostate or colorectal cancer survivors were interviewed.
RESULTS
The overarching theme was that HPs' desire to provide lifestyle advice was not necessarily matched by knowledge and action. Three main themes were identified: (1) survivorship-centred barriers to provision, (2) HP-centred barriers to provision, and (3) optimal delivery of lifestyle advice. Results suggested that HPs' perceptions of survivors' current status of practising health behaviours, their perceived socioeconomic barriers and ability to practise health behaviours, and HPs' fear for potential loss of connection with the patient influenced provision of lifestyle advice. Further factors included HPs' knowledge of healthy lifestyle guidelines, feeling that they were not the 'right person' to provide advice, and lack of time and resources. HPs stressed that the optimal delivery of lifestyle advice should (1) be tailored to the individual and delivered throughout the cancer journey, (2) be focused on small and achievable changes framed as part of their treatment regimen and (3) be cost-effective for wide-scale implementation.
CONCLUSIONS
Incorporation of the identified barriers when developing HP training programmes and lifestyle interventions could increase the probability of successful behavioural change, and thus improve outcomes for cancer survivors.
目的
采取健康的生活方式行为已显示出在减轻癌症幸存者高发病负担方面有显著成效。健康专业人员（HPs）非常适合提供生活方式建议，但很少有幸存者报告从他们那里得到过指导。本研究旨在探讨健康专业人员对癌症幸存者生活方式建议（关于健康饮食、体育活动、吸烟和饮酒）的看法。
设计
通过电话或面对面进行深入的半结构化定性访谈。使用定性内容分析法对数据进行分析。
背景与参与者
对21名在二级护理机构工作、接触乳腺癌、前列腺癌或结直肠癌幸存者的英国健康专业人员进行了访谈。
结果
首要主题是健康专业人员提供生活方式建议的意愿不一定与知识和行动相匹配。确定了三个主要主题：（1）以幸存者为中心的提供建议的障碍，（2）以健康专业人员为中心的提供建议的障碍，以及（3）生活方式建议的最佳提供方式。结果表明，健康专业人员对幸存者当前健康行为实践状况的看法、他们所感知的社会经济障碍和健康行为实践能力，以及健康专业人员对与患者潜在联系丧失的担忧影响了生活方式建议的提供。其他因素包括健康专业人员对健康生活方式指南的了解、觉得自己不是提供建议的“合适人选”，以及缺乏时间和资源。健康专业人员强调，生活方式建议的最佳提供方式应（1）针对个体并贯穿癌症治疗全程，（2）专注于作为治疗方案一部分的小的、可实现的改变，以及（3）具有成本效益以便大规模实施。
结论
在制定健康专业人员培训计划和生活方式干预措施时纳入已确定的障碍，可能会增加行为成功改变的可能性，从而改善癌症幸存者的预后。
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