Lengoc Sonca, Soo Jenny, McGahan Colleen E, French John, Tyldesley Scott, Olson Robert
Department of Radiation Therapy, BCCA, Vancouver Centre, Vancouver, BC.
Cancer Surveillance & Outcomes, BCCA, Vancouver Centre, Vancouver, BC.
J Med Imaging Radiat Sci. 2012 Sep;43(3):161-167. doi: 10.1016/j.jmir.2012.05.001. Epub 2012 Jun 29.
Previous studies have shown that palliative radiation therapy (PRT) is often underused, especially in rural and remote settings despite evidence supporting its effectiveness in managing symptoms from advanced or metastatic cancer.
To identify factors which influence family physicians (FPs) in British Columbia (BC) to refer patients for PRT at the BC Cancer Agency (BCCA) and to compare referral patterns between FPs in rural and urban areas.
A total of 1,001 questionnaires were sent to all FPs practicing in rural areas and randomly to FPs in urban areas (351 and 650, respectively). Rural and urban areas were chosen based on our previous study of utilization rates of PRT in BC. The questionnaire was adapted from a previously validated survey, and was used to obtain information on referral practices of FPs in BC. FPs who did not practice family medicine or where 80% of their practice was spent with either obstetrical or pediatric patients were excluded.
The overall response rate was 33% (44% rural vs. 28% urban). Rural FPs were more involved in both palliative care and metastatic cancer management of their patients (88% vs. 74%; P = .01 and 58% vs. 39%; P = .01). No difference was observed in the FPs' awareness of the BCCA's Radiation Oncology Program. The most significant factors influencing an FP to refer a patient for PRT were: poor functional status, inconvenience to travel and life expectancy. A higher proportion of rural FPs had 10 years or less of experience in family practice than the urban FPs (P = .03). There was no significant difference in the formal training or additional training between the rural and urban FPs.
This study found that FPs practicing in rural areas were more involved in palliative management of their patients and participated more in the care of patients with advanced or metastatic cancer than those in urban areas. They also more commonly referred patients for palliative radiotherapy than their urban counterparts. The reported factors that influenced rural and urban FPs to refer were patients' functional status and life expectancy, combined with uncertain benefit and potential side effects of radiotherapy. More than twice as many FPs from rural compared to urban areas were influenced by perceived inconvenience to travel for palliative radiotherapy. After controlling for potential confounding factors, FP awareness of the radiotherapy program, high participation in advanced, metastatic, or palliative care of cancer patients, formal training in radiation oncology, and additional training in palliative care were all associated with an increased probability of ever referring for palliative radiotherapy.
既往研究表明，姑息性放射治疗（PRT）的应用常常不足，尤其是在农村和偏远地区，尽管有证据支持其在控制晚期或转移性癌症症状方面的有效性。
确定影响不列颠哥伦比亚省（BC）家庭医生（FP）将患者转介至BC癌症机构（BCCA）接受PRT的因素，并比较农村和城市地区FP的转介模式。
共向所有在农村地区执业的FP以及随机抽取的城市地区FP（分别为351名和650名）发送了1001份问卷。农村和城市地区是根据我们之前对BC省PRT利用率的研究选定的。该问卷改编自先前经过验证的调查，用于获取BC省FP转介实践的信息。不从事家庭医学或80%的执业时间用于产科或儿科患者的FP被排除。
总体回复率为33%（农村地区为44%，城市地区为28%）。农村FP更多地参与其患者的姑息治疗和转移性癌症管理（88%对74%；P = 0.01以及58%对39%；P = 0.01）。在FP对BCCA放射肿瘤学项目的认知方面未观察到差异。影响FP将患者转介接受PRT的最显著因素为：功能状态差、出行不便和预期寿命。农村FP中从事家庭医学10年及以下的比例高于城市FP（P = 0.03）。农村和城市FP在正规培训或额外培训方面无显著差异。
本研究发现，与城市地区的FP相比，在农村地区执业的FP更多地参与其患者的姑息治疗管理，并且更多地参与晚期或转移性癌症患者的护理。他们也比城市同行更常将患者转介接受姑息性放疗。报告的影响农村和城市FP转介的因素为患者的功能状态和预期寿命，以及放疗的获益不确定性和潜在副作用。与城市地区相比，农村地区因认为姑息性放疗出行不便而受到影响的FP数量是城市地区的两倍多。在控制潜在混杂因素后，FP对放疗项目的认知、对癌症患者晚期、转移性或姑息治疗的高参与度、放射肿瘤学正规培训以及姑息治疗额外培训均与曾将患者转介接受姑息性放疗的可能性增加相关。
