Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.
BMC Health Serv Res. 2020 Mar 26;20(1):252. doi: 10.1186/s12913-020-05107-7.
Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34-43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients' needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals' (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment.
A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis.
Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation.
This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today's BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients', rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment.
乳腺癌（BC）及其相关治疗与广泛的持续性残疾风险相关。尽管该领域进行了广泛的研究，并更加关注 BC 康复，但仍有 34-43%的患者存在慢性困扰的风险。此外，已知这些患者反复报告未满足的需求，这与生活质量的降低密切相关。然而，尽管患者在 BC 康复期间对支持的需求存在很大差异，但通常缺乏个性化康复。因此，本研究旨在探讨医疗保健专业人员（HCP）对当前康复实践的经验，并描述当前在 BC 治疗后患者个性化康复的障碍和促进因素。
共纳入 19 名 HCP，代表瑞典一所大学医院的外科、肿瘤学和专门癌症康复单位中 BC 护理/康复的各个专业。进行了 5 次半结构化焦点小组访谈，并使用常规定性内容分析进行归纳分析。
捕捉到了三个类别：（1）对康复的态度不同；（2）在如何识别和满足康复需求方面存在不一致；（3）在癌症治疗过程中协作不佳。结果表明，在如何优化个性化康复方面缺乏共识。它还阐明了促进个性化康复的因素，例如与长期治疗 BC 患者的护理/康复相关的广泛能力。此外，分析还揭示了一些障碍，例如在以医学和治疗为导向的医疗保健系统中促进个性化康复的复杂性，该系统缺乏结构和知识，以及缺乏全面的康复协作。
本研究表明，癌症轨迹以医学和治疗为导向，康复在当今的 BC 轨迹中发挥着边缘作用。它还表明，缺乏用于系统筛查需求的结构、个性化康复干预措施的循证指南以及用于转介患者接受高级康复的结构。为了使 BC 患者获得最佳和个性化的康复，康复需要成为癌症轨迹的一个组成部分，并与诊断和治疗并行。
