在初始癌症治疗期间的提供者参与度和初始治疗后患者对提供者角色的偏好。
Provider Involvement in Care During Initial Cancer Treatment and Patient Preferences for Provider Roles After Initial Treatment.
机构信息
1 University of Michigan, Ann Arbor, MI.
2 University of Southern California, Los Angeles, CA.
出版信息
J Oncol Pract. 2019 Apr;15(4):e328-e337. doi: 10.1200/JOP.18.00497. Epub 2019 Mar 11.
PURPOSE
Patients report strong preferences regarding which provider-oncologist or primary care provider (PCP)-handles their primary care after initial cancer treatment (eg, other cancer screenings, preventive care, comorbidity management). Little is known about associations between provider involvement during initial cancer treatment and patient preferences for provider roles after initial treatment.
METHODS
Women who received a diagnosis of early-stage breast cancer in 2014 to 2015 were identified from the Georgia and Los Angeles County SEER registries and surveyed (N = 2,502; 68% response rate). Women reported the level of their providers' involvement in their care during initial cancer treatment. Associations between level of medical oncologist's participation and PCP's engagement during initial cancer treatment and patient preferences for oncologist led ( v PCP led) other cancer screenings after initial treatment were examined using multivariable logistic regression models.
RESULTS
During their initial cancer treatment, 20% of women reported medical oncologists participated substantially in delivering primary care and 66% reported PCPs were highly engaged in their cancer care. Two-thirds (66%) of women preferred medical oncologists to handle other cancer screenings after initial treatment. Women who reported substantial medical oncologist participation in primary care were more likely (adjusted odds ratio, 1.42; 95% CI, 1.05 to 1.91) and those who reported high PCP engagement in cancer care were less likely (adjusted odds ratio, 0.41; 95% CI, 0.31 to 0.53) to prefer oncologist-led other cancer screenings after initial treatment.
CONCLUSIONS
Providers' involvement during initial cancer treatment may affect patient preferences regarding provision of follow-up primary care. Clarifying provider roles as early as during cancer treatment may help to better delineate their roles throughout survivorship.
目的
患者对于初始癌症治疗后由哪位医生（肿瘤内科医生或初级保健医生[PCP]）负责其初级保健有强烈的偏好，例如其他癌症筛查、预防保健、合并症管理。对于初始癌症治疗期间医生的参与与患者对初始治疗后医生角色的偏好之间的关联，人们知之甚少。
方法
从佐治亚州和洛杉矶县 SEER 登记处确定了 2014 年至 2015 年期间被诊断为早期乳腺癌的女性，并对其进行了调查（N=2502；回应率为 68%）。女性报告了其在初始癌症治疗期间医生对其治疗的参与程度。使用多变量逻辑回归模型，研究了初始癌症治疗期间肿瘤内科医生参与度和 PCP 参与度与患者对初始治疗后肿瘤内科医生主导（v 由 PCP 主导）其他癌症筛查的偏好之间的关联。
结果
在初始癌症治疗期间，20%的女性报告称肿瘤内科医生在提供初级保健方面有很大的参与度，66%的女性报告称 PCP 在癌症治疗方面的参与度很高。三分之二（66%）的女性希望在初始治疗后由肿瘤内科医生来进行其他癌症筛查。报告称肿瘤内科医生在初级保健方面有很大参与度的女性更有可能（调整后的优势比，1.42；95%置信区间，1.05 至 1.91），而报告称 PCP 在癌症治疗方面有很高参与度的女性不太可能（调整后的优势比，0.41；95%置信区间，0.31 至 0.53）希望由肿瘤内科医生主导其他癌症筛查。
结论
初始癌症治疗期间医生的参与可能会影响患者对提供后续初级保健的偏好。在癌症治疗期间尽早明确医生的角色，可能有助于在整个生存期间更好地划定他们的角色。
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