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“第 100 天谈话”的可行性和可接受性:儿童癌症治疗头 6 个月期间的一项跨学科交流干预。

Feasibility and acceptability of the "Day 100 Talk": An interdisciplinary communication intervention during the first six months of childhood cancer treatment.

机构信息

Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.

出版信息

Cancer. 2021 Apr 1;127(7):1134-1145. doi: 10.1002/cncr.33362. Epub 2020 Dec 15.

Abstract

BACKGROUND

Communication gaps arise early in the childhood cancer trajectory and may persist. The authors conducted a pilot study of the feasibility and acceptability of a communication intervention, the Day 100 Talk (D100). D100 involves an interprofessional family conference during initial months of treatment between oncologists, psychosocial clinicians, and parents, facilitated by a 3-part conversation tool.

METHODS

The authors enrolled English-speaking parents of children with nonrelapsed, nonprogressive cancer who were receiving continuity care from enrolled pediatric oncologists and psychosocial clinicians at a single site. The a priori feasibility threshold was 60% parent completion of the D100 intervention. Surveys from parents and professionals and debrief interviews with professionals assessed D100 acceptability.

RESULTS

Thirty-seven parents (77%) and 38 oncology professionals (67%) enrolled. Twenty of 33 evaluable parents (61%) participated in a D100 family conference. Most commonly, parents did not complete the D100 intervention because of scheduling difficulties related to clinical team constraints. All 17 parents who completed a post-D100 survey agreed or strongly agreed that D100 participation was helpful. In debrief interviews, professionals identified D100 benefits, namely, stepping back to the big picture and getting on the same page, and barriers related to logistical challenges and professionals' anticipatory dread.

CONCLUSIONS

The D100 intervention pilot demonstrates high acceptability among parents of children with cancer. Despite meeting the prespecified feasibility threshold, findings highlight important barriers to D100 dissemination, namely, perceived burdens on professionals. Potential strategies to reduce burden may include using virtual visit platforms, incorporating D100 elements across multiple visits, or prioritizing intervention delivery to parents with the greatest need for enhanced communication.

摘要

背景

在儿童癌症病程早期就会出现沟通障碍,且这些障碍可能持续存在。作者开展了一项关于 Day 100 Talk(D100)这一沟通干预措施可行性和可接受性的试点研究。D100 是一种在治疗初始阶段由肿瘤学家、心理社会临床医生和家长参与的多学科家庭会议,由三部分对话工具促成。

方法

作者招募了来自单一机构的、正在接受入组肿瘤学家和心理社会临床医生连续性治疗的、英语为母语的、患有非复发和非进展性癌症的儿童的家长。家长完成 D100 干预的预先设定的可行性阈值为 60%。采用家长和专业人员的问卷调查以及专业人员的情况汇报访谈来评估 D100 的可接受性。

结果

37 名家长(77%)和 38 名肿瘤学专业人员(67%)入组。20 名(61%)可评估的家长参加了 D100 家庭会议。最常见的是,由于与临床团队限制相关的日程安排困难,家长未完成 D100 干预。17 名完成 D100 后调查的家长全部表示或强烈表示 D100 参与有帮助。在情况汇报访谈中,专业人员确定了 D100 的益处,即退后一步关注大局并达成一致,以及与后勤挑战和专业人员的预期恐惧相关的障碍。

结论

D100 干预试点研究显示癌症患儿家长对此干预措施接受度较高。尽管达到了预设的可行性阈值,但研究结果突出了 D100 传播的重要障碍,即专业人员认为这会带来负担。可能的减轻负担策略包括使用虚拟访问平台、在多次就诊中纳入 D100 元素,或优先向最需要增强沟通的家长提供干预措施。

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