University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska.
Public Health Nurs. 2019 Jul;36(4):545-550. doi: 10.1111/phn.12615. Epub 2019 Apr 9.
Cancer-related fatigue (CRF) is an important public health issue that involves millions of community-dwelling cancer survivors. CRF is the most debilitating patient reported symptom related to cancer therapies and exacts a significant economic and social toll. It adversely impacts patients' work, social relationships, and overall quality of life. CRF prevalence ranges from 30% to 90% during therapy and often persists months and years afterwards. This policy analysis examines the problem of lack of patient access to evidence-based nonpharmacologic CRF therapies. The authors use a five-step process described by Teitelbaum & Wilenski (2017) to address the problem statement, identify key stakeholders, explore problem landscape, describe two viable policy options, and make a recommendation. The two policy options considered were: (a) insurer reimbursements modeled after existing cardiac rehabilitation programs and (b) health care provider incentives that incorporate the oncology care model (OCM) quality measure. Advantages and disadvantages of both options are presented. Public health nurses are uniquely positioned in their communities to advocate for these changes to improve population health.
癌症相关疲劳（CRF）是一个重要的公共卫生问题，涉及数以百万计的社区癌症幸存者。CRF 是癌症治疗中最具致残性的患者报告症状之一，对经济和社会造成了重大影响。它会对患者的工作、社交关系和整体生活质量产生负面影响。在治疗期间，CRF 的患病率在 30%到 90%之间，并且经常在治疗后持续数月甚至数年。本政策分析研究了患者无法获得基于证据的非药物性 CRF 治疗的问题。作者使用了 Teitelbaum 和 Wilenski（2017）描述的五个步骤来解决问题陈述，确定关键利益相关者，探索问题领域，描述两种可行的政策选择，并提出建议。考虑的两种政策选择是：（a）效仿现有心脏康复计划的保险公司报销模式，以及（b）纳入肿瘤护理模式（OCM）质量衡量标准的医疗保健提供者激励措施。这两种选择的优缺点都进行了阐述。公共卫生护士在其社区中处于独特的地位，可以倡导这些变革，以改善人口健康。
