Division of General Internal Medicine, Magee Womens' Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Room 3526, Pittsburgh, PA, USA.
Geriatric Oncology Solutions, La Jolla, CA, USA.
J Cancer Educ. 2020 Dec;35(6):1219-1226. doi: 10.1007/s13187-019-01585-4.
Recent cancer care delivery models and clinical practice guidelines have expanded the role of primary care providers (PCPs) in routine follow-up of cancer survivors. We conducted a cross-sectional survey of PCPs affiliated with a large healthcare system to (1) examine practices, attitudes, and beliefs regarding preparedness to provide survivorship care and (2) explore predictors of confidence managing cancer survivors. We distributed a self-administered online survey to 1069 clinical affiliates providing primary care services within the University of Pittsburgh Medical Center system. Associations between PCPs' professional characteristics and attitudes and preparedness were evaluated. Multiple logistic regression explored predictors of confidence monitoring common cancer treatment-related symptoms. One hundred twenty-seven eligible PCPs responded. The sample was split between academic and community practice (48.0% vs. 52.0%, respectively), predominantly comprised of physicians (81.8%), and 64.6% had > 15 years direct patient care experience. The majority agreed that PCPs play a valuable role in surveillance and adverse event monitoring in survivors, though less than 25% felt their professional training prepared them to perform each of these domains. Physicians were significantly more likely than advanced practice providers to be among the 65% of PCPs who were confident monitoring ≥ 1 symptom in each of the 5 evaluated symptom clusters (OR 3.6, 95% CI 1.2-10.8). PCPs appear willing to assume an enhanced role in cancer survivorship care but feel unprepared to do so. Enhanced training and dissemination of clinical practice guidelines are needed to facilitate effective implementation of PCP-delivered survivorship care.
最近的癌症护理提供模式和临床实践指南扩大了初级保健提供者(PCP)在癌症幸存者常规随访中的作用。我们对隶属于大型医疗保健系统的 PCP 进行了横断面调查,以(1)检查他们在提供生存护理方面的准备情况、态度和信念,以及(2)探讨管理癌症幸存者的信心的预测因素。我们向匹兹堡大学医学中心系统内提供初级保健服务的 1069 名临床附属机构的临床医生分发了一份自我管理的在线调查。评估了 PCP 专业特征与其态度和准备情况之间的关系。多变量逻辑回归探讨了监测常见癌症治疗相关症状的信心的预测因素。有 127 名符合条件的 PCP 做出了回应。该样本分为学术和社区实践(分别为 48.0%和 52.0%),主要由医生(81.8%)组成,并且有 64.6%的人有超过 15 年的直接患者护理经验。大多数人认为 PCP 在监测和幸存者不良事件监测方面发挥着有价值的作用,尽管不到 25%的人认为他们的专业培训使他们能够执行这些领域中的每一个领域。与高级执业医师相比,医生更有可能成为有信心监测 5 个评估症状群中的每个症状群中的≥1 个症状的 65%的 PCP 之一(OR 3.6,95%CI 1.2-10.8)。PCP 似乎愿意在癌症生存护理中承担增强的角色,但感到没有准备好这样做。需要增强培训和传播临床实践指南,以促进 PCP 提供的生存护理的有效实施。