University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK.
University of Surrey, School of Health Sciences, Guildford, Surrey, GU2 7XH, UK.
BMC Cancer. 2019 Apr 23;19(1):368. doi: 10.1186/s12885-019-5561-0.
Alternative models of cancer follow-up care are needed to ameliorate pressure on services and better meet survivors' long-term needs. This paper reports an evaluation of a service improvement initiative for the follow-up care of prostate cancer patients based on remote monitoring and supported self-management.
This multi-centred, historically controlled study compared patient reported outcomes of men experiencing the new Programme with men experiencing a traditional clinic appointment model of follow-up care, who were recruited in the period immediately prior to the introduction of the Programme. Data were collected by self-completed questionnaires, with follow up measurement at four and eight months post-baseline. The primary outcome was men's unmet survivorship needs, measured by the Cancer Survivors' Unmet Needs Survey. Secondary outcomes included cancer specific quality of life, psychological wellbeing and satisfaction with care. The analysis was intention to treat. Regression analyses were conducted for outcomes at each time point separately, controlling for pre-defined clinical and demographic variables. All outcome analyses are presented in the paper. Costs were compared between the two groups.
Six hundred and twenty-seven men (61%) were consented to take part in the study (293 in the Programme and 334 in the comparator group.) Regarding the primary measure of unmet survivorship needs, 25 of 26 comparisons favoured the Programme, of which 4 were statistically significant. For the secondary measures of activation for self-management, quality of life, psychological well-being and lifestyle, 20 of 32 comparisons favoured the Programme and 3 were statistically significant. There were 22 items on the satisfaction with care questionnaire and 13 were statistically significant. Per participant costs (British pounds, 2015) in the 8 month follow up period were slightly lower in the programme than in the comparator group (£289 versus £327). The Programme was acceptable to patients.
The Programme is shown to be broadly comparable to traditional follow-up care in all respects, adding to evidence of the viability of such models.
需要替代的癌症随访护理模式来缓解服务压力，更好地满足患者的长期需求。本文报告了一项基于远程监测和支持自我管理的前列腺癌患者随访护理服务改进计划的评估结果。
这是一项多中心、历史性对照研究，比较了接受新方案患者和接受传统门诊随访护理模式患者的患者报告结局，后者是在新方案引入前招募的。数据通过自我完成的问卷收集，在基线后 4 个月和 8 个月进行随访测量。主要结局是通过癌症幸存者未满足的需求调查来衡量患者的生存需求。次要结局包括癌症特异性生活质量、心理健康和护理满意度。分析采用意向治疗。在每个时间点分别进行回归分析，控制预先定义的临床和人口统计学变量。所有结果分析均在论文中报告。比较了两组之间的成本。
共有 627 名男性（61%）同意参加研究（方案组 293 名，对照组 334 名）。关于未满足的生存需求的主要测量指标，26 项比较中有 25 项有利于方案组，其中 4 项具有统计学意义。对于自我管理积极性、生活质量、心理健康和生活方式的次要测量指标，方案组有 20 项优于对照组，其中 3 项具有统计学意义。护理满意度问卷有 22 个项目，其中 13 个具有统计学意义。在 8 个月的随访期间，方案组每个参与者的成本（2015 年英镑）略低于对照组（289 英镑对 327 英镑）。该方案得到了患者的认可。
方案在所有方面均与传统随访护理相当，进一步证明了这种模式的可行性。
