Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer. 2019 Nov 1;125(21):3864-3872. doi: 10.1002/cncr.32391. Epub 2019 Jul 9.
The current study was conducted to assess self-reported comfort levels of pediatric primary care providers (PCPs) in providing acute medical care to patients with childhood cancer who currently were receiving therapy (on-therapy patients) and health maintenance care to childhood cancer survivors, independently and in conjunction with pediatric oncologists, along with confidence levels regarding knowledge about immunizations for survivors. All levels were measured using 7-point Likert scales.
A cross-sectional, 23-item survey mailed to practicing PCPs affiliated with a tertiary children's hospital was analyzed.
The response rate was 64.4% (259 of 402 eligible PCPs). The mean PCP comfort level was higher when collaborating with a pediatric oncologist to provide acute medical care for on-therapy patients and health maintenance care for childhood cancer survivors (mean ratings of 6.0 ± 1.5 and 6.4 ± 1.3, respectively) compared with independently providing such care (mean ratings of 4.6 ± 1.8 and 5.0 ± 1.7, respectively; P < .0001). Only approximately 30% of PCPs were confident in their knowledge regarding immunizations for survivors. Certain factors were found to be associated with PCP comfort in providing care in conjunction with a pediatric oncologist. For acute care, these factors were rural location compared with urban location (odds ratio [OR], 5.0; 95% CI, 1.9-13.1 [P = .03]) and having cared for ≥6 on-therapy patients within the past year versus none (OR, 3.8; 95% CI, 1.9-7.5 [P = .0001]). For survivor health maintenance care, practice location <50 miles from pediatric oncology specialty care versus ≥50 miles was the only factor found to be associated with PCP comfort (OR, 2.8; 95% CI, 1.3-6.1 [P = .009]).
The findings of the current study underscore the need for collaboration between pediatric oncologists and PCPs when caring for children with cancer across the spectrum of care.
本研究旨在评估儿科初级保健提供者（PCP）在为正在接受治疗（治疗中患者）和接受癌症存活者健康维护的儿童癌症患者提供急性医疗护理方面的自我报告舒适度，以及在与儿科肿瘤医生合作时的信心水平，以及对癌症存活者免疫接种知识的信心水平。所有水平均使用 7 点 Likert 量表进行测量。
对一家三级儿童医院附属的实践 PCP 进行了横断面、23 项调查。
对 23 项调查的回应率为 64.4%（259 名符合条件的 PCP 中的 259 名）。与独立提供此类护理相比，当与儿科肿瘤医生合作提供治疗中患者的急性医疗护理和癌症存活者的健康维护护理时，PCP 的舒适度更高（平均评分分别为 6.0±1.5 和 6.4±1.3）（分别；P<.0001）。只有约 30%的 PCP 对其关于癌症存活者免疫接种的知识有信心。发现某些因素与 PCP 在与儿科肿瘤医生合作提供护理时的舒适度相关。对于急性护理，这些因素是与城市相比的农村位置（优势比[OR]，5.0；95%置信区间，1.9-13.1[P=.03]）和过去一年中照顾过≥6 名治疗中患者而不是没有照顾过的患者（OR，3.8；95%置信区间，1.9-7.5[P=.0001]）。对于癌症存活者的健康维护护理，与儿科肿瘤学专业护理地点的距离<50 英里与≥50 英里是唯一与 PCP 舒适度相关的因素（OR，2.8；95%置信区间，1.3-6.1[P=.009]）。
本研究的结果强调了儿科肿瘤医生和 PCP 之间在儿童癌症护理全过程中进行合作的必要性。
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