在癌症全程中彰显患者价值观：一种新型护士主导的干预措施。
Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention.
机构信息
Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
出版信息
J Pain Symptom Manage. 2019 Jul;58(1):72-79.e2. doi: 10.1016/j.jpainsymman.2019.04.028. Epub 2019 Apr 26.
CONTEXT
Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds.
OBJECTIVES
Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients.
METHODS
Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies.
RESULTS
Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process.
CONCLUSION
Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.
背景
最佳的预先医疗照护计划可让患者表达其价值观，作为医疗决策的基准。理想情况下，这发生在患者临床状况稳定时，并随着临床情况的发展有机会进行迭代。
目的
在繁忙的肿瘤门诊诊所中测试一种新型计划的可行性和可接受性，该计划由肿瘤护士对所有新癌症患者进行系统的、以价值观为导向的讨论。
方法
在一项将初级和专科姑息治疗从诊断开始整合到所有癌症患者中的机构倡议中，肿瘤护士接受了培训，以便在门诊就诊期间使用特定问题和同理心沟通框架讨论与健康相关的价值观。护士会根据模板总结讨论内容，供患者验证、肿瘤医生审查和电子病历记录。至少每季度与患者一起审查摘要。在三个血液系统或胃肠道恶性肿瘤的诊所中评估了可行性和可接受性。
结果
在两年内，肿瘤护士共与 67 名新诊断的癌症患者（17 名血液系统恶性肿瘤患者和 50 名胃肠道恶性肿瘤患者）进行了 177 次讨论。没有患者拒绝参与。讨论平均持续八分钟，所有患者均验证了价值观摘要。诊所的患者量得以维持。在接受调查的 31 名患者中，30 名（97%）表示对该过程感到舒适，认为该过程有帮助，并将向他人推荐。临床医生强烈认可该价值观讨论过程。
结论
在繁忙的肿瘤门诊诊所中，新诊断后由护士主导的患者价值观讨论是可行且可接受的。在我们机构更广泛地推广这一举措后，将进一步研究这种新方法对其他以患者为导向的结果的影响。
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