1 Durham VA GRECC, Duke Center for the Study of Aging and Human Development; Sanford School of Public Policy, Duke University , Durham, North Carolina.
2 Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.
J Palliat Med. 2018 Aug;21(8):1074-1077. doi: 10.1089/jpm.2017.0605. Epub 2018 Apr 23.
Best supportive care (BSC) is often not standardized across sites, consistent with best evidence, or sufficiently described. We developed a consensus-based checklist to document BSC delivery, including symptom management, decision making, and care planning. We hypothesized that BSC can be feasibly documented with this checklist consistent with consolidated standards of reporting trials.
To determine feasibility/acceptability of a BSC checklist among clinicians.
To test feasibility of a BSC checklist in standard care, we enrolled a sample of clinicians treating patients with advanced cancer at four centers. Clinicians were asked to complete the checklist at eligible patient encounters. We surveyed enrollees regarding checklist use generating descriptive statistics and frequencies.
We surveyed 15 clinicians and 9 advanced practice providers. Mean age was 41 (SD = 7.9). Mean years since fellowship for physicians was 7.2 (SD = 4.5). Represented specialties are medical oncology (n = 8), gynecologic oncology (n = 4), palliative care (n = 2), and other (n = 1). For "overall impact on your delivery of supportive/palliative care," 40% noted improved impact with using BSC. For "overall impact on your documentation of supportive/palliative care," 46% noted improvement. Impact on "frequency of comprehensive symptom assessment" was noted to be "increased" by 33% of providers. None noted decreased frequency or worsening impact on any measure with use of BSC. Regarding feasibility of integrating the checklist into workflow, 73% agreed/strongly agreed that checklists could be easily integrated, 73% saw value in integration, and 80% found it easy to use.
Clinicians viewed the BSC checklist favorably illustrating proof of concept, minor workflow impact, and potential of benefit to patients.
最佳支持治疗（BSC）在各站点之间通常没有标准化，与最佳证据不一致，或描述不充分。我们制定了一个基于共识的清单，以记录 BSC 的提供情况，包括症状管理、决策制定和护理计划。我们假设，通过这个清单可以合理地记录 BSC，符合临床试验报告的统一标准。
确定 BSC 清单在临床医生中的可行性/可接受性。
为了测试 BSC 清单在标准护理中的可行性，我们在四个中心招募了一组治疗晚期癌症患者的临床医生。要求临床医生在符合条件的患者就诊时完成清单。我们对参与者进行了清单使用情况的调查，生成了描述性统计数据和频率。
我们调查了 15 名临床医生和 9 名高级执业护士。平均年龄为 41 岁（标准差=7.9）。医生的专科培训年限平均为 7.2 年（标准差=4.5）。代表的专业包括肿瘤内科（n=8）、妇科肿瘤学（n=4）、姑息治疗（n=2）和其他（n=1）。对于“对你提供支持/姑息治疗的整体影响”，40%的人认为使用 BSC 会提高影响。对于“对你支持/姑息护理记录的整体影响”，46%的人认为有改善。有 33%的提供者认为“全面症状评估的频率”有所增加。没有人认为使用 BSC 会降低任何指标的频率或降低影响。关于将清单整合到工作流程中的可行性，73%的人同意/强烈同意清单可以轻松整合，73%的人认为整合有价值，80%的人认为使用方便。
临床医生对 BSC 清单的看法是有利的，这证明了概念的可行性、对工作流程的微小影响以及对患者可能的益处。
