Behavioral and Epidemiology Research Group, American Cancer Society, Inc, Atlanta, GA, USA.
American Cancer Society, Inc, Washington, DC, USA.
J Natl Cancer Inst. 2020 Dec 14;112(12):1183-1189. doi: 10.1093/jnci/djaa053.
Development of personalized, stratified follow-up care pathways where care intensity and setting vary with needs could improve cancer survivor outcomes and efficiency of health-care delivery. Advancing such an approach in the United States requires identification and prioritization of the most pressing research and data needed to create and implement personalized care pathway models. Cancer survivorship research and care experts (n = 39) participated in an in-person workshop on this topic in 2018. Using a modified Delphi technique-a structured, validated system for identifying consensus-an expert panel identified critical research questions related to operationalizing personalized, stratified follow-up care pathways for individuals diagnosed with cancer. Consensus for the top priority research questions was achieved iteratively through 3 rounds: item generation, item consolidation, and selection of the final list of priority research questions. From the 28 research questions that were generated, 11 research priority questions were identified. The questions were categorized into 4 priority themes: determining outcome measures for new care pathways, developing and evaluating new care pathways, incentivizing new care pathway delivery, and providing technology and infrastructure to support self-management. Existing data sources to begin answering questions were also identified. Although existing data sources, including cancer registry, electronic medical record, and health insurance claims data, can be enhanced to begin addressing some questions, additional research resources are needed to address these priority questions.
制定个性化、分层的随访护理路径,根据需求调整护理强度和场所,可改善癌症生存者的结局并提高医疗保健提供效率。在美国推进这一方法需要确定和优先考虑最紧迫的研究和数据,以创建和实施个性化护理路径模型。癌症生存研究和护理专家(n=39)于 2018 年参加了一次关于这一主题的现场研讨会。使用改良德尔菲技术(一种用于确定共识的结构化、经过验证的系统),一个专家小组确定了与实施针对癌症确诊个体的个性化、分层随访护理路径相关的关键研究问题。通过 3 轮:项目生成、项目整合和最终优先研究问题清单的选择,逐步达成了对优先级最高的研究问题的共识。从生成的 28 个研究问题中,确定了 11 个研究优先问题。这些问题分为 4 个优先主题:确定新护理路径的结果衡量标准、开发和评估新护理路径、激励新护理路径的提供以及提供技术和基础设施以支持自我管理。还确定了开始回答问题的现有数据源。尽管现有的数据源,包括癌症登记处、电子病历和医疗保险索赔数据,可以进行增强以开始解决一些问题,但仍需要额外的研究资源来解决这些优先问题。