Devictor Julie, Leclercq Anne, Hazo Jean-Baptiste, Burnet Espérie, Jovic Ljiljana, Bouattour Mohamed, Ganne-Carrié Nathalie
AP-HP, Hôpital Beaujon, DIGEST, Clichy, France; ECEVE, UMRS 1123, INSERM, Paris, France; Université de Paris, Paris, France.
AP-HP, Hôpital Beaujon, Direction des soins, Clichy, France.
Clin Res Hepatol Gastroenterol. 2021 May;45(3):101650. doi: 10.1016/j.clinre.2021.101650. Epub 2021 Feb 17.
Hepatocellular carcinoma (HCC) mostly occurs in patients with chronic liver disease (CLD). HCC treatment may have a direct impact on CLD prognosis. HCC management can therefore become complex, involving multiple health care providers, such as oncologists, hepatologists, radiologists, and surgeons. In France, dedicated nurses have been involved in patient care pathways. Their impact is poorly documented.
To determine the country-wide distribution of HCC nurse coordinators in French health care settings and to describe their roles and responsibilities.
A survey using a multi-item questionnaire (including center characteristics, nurse coordinator characteristics, and quality indicators such as patient care pathway initiation timeline, scheduled length of hospital stay, diagnostic disclosure process) was conducted. All French liver cancer centers planning to participate in a prospective national cohort study for patients with HCC (CHIEF Cohort) were invited to take part in the survey. Bivariate analysis compared centers with a nurse coordinator to those without.
Among the 42 of 72 centers that replied, 14 treated fewer than 75 HCC patients. Treatment mostly took place in hepatology units (34/42). Sixteen nurse coordinators were part of the health care team in 13 of the 42 centers. Among these 13 centers, 11 were university hospitals and 11 followed more than 75 patients per year. The median number of patients followed in these centers was 300 (min-max 44-600) in 2017. All nurse coordinators were involved in providing patient information and counseling. Other roles included treatment monitoring (13/16), care coordination (12/16), psychological support (12/16) and treatment planning (11/16). Thirteen nurse coordinators conducted diagnostic disclosure nurse consultations; seven conducted initial patient contact consultations; and six held outpatient nurse consultations, with wide heterogeneity between centers. The presence of a nurse coordinator was associated with completion of the full diagnostic disclosure process (p = 0.045).
In France, nurse coordinators for HCC patient pathway management are present mainly in university hepatology units with a caseload of more than 75 patients per year. All provide patient information and counseling but their roles in care coordination, patient support and holistic assessment are heterogeneous and not standardized.
肝细胞癌（HCC）大多发生于慢性肝病（CLD）患者。HCC治疗可能对CLD预后产生直接影响。因此，HCC的管理可能会变得复杂，涉及多个医疗服务提供者，如肿瘤学家、肝病学家、放射科医生和外科医生。在法国，专门的护士参与了患者护理路径。其影响的记录很少。
确定法国医疗环境中HCC护士协调员的全国分布情况，并描述他们的角色和职责。
进行了一项使用多项目问卷的调查（包括中心特征、护士协调员特征以及患者护理路径启动时间、预定住院时间、诊断披露过程等质量指标）。所有计划参与一项针对HCC患者的前瞻性全国队列研究（CHIEF队列）的法国肝癌中心均受邀参加该调查。双变量分析比较了设有护士协调员的中心和没有护士协调员的中心。
在72个回复的中心中的42个中心中，14个中心治疗的HCC患者少于75例。治疗大多在肝病科进行（34/42）。16名护士协调员是42个中心中13个中心医疗团队的成员。在这13个中心中，11个是大学医院，11个中心每年跟踪超过75名患者。2017年这些中心跟踪患者的中位数为300例（最小值 - 最大值44 - 600）。所有护士协调员都参与提供患者信息和咨询。其他角色包括治疗监测（13/16）、护理协调（12/16）、心理支持（12/16）和治疗计划（11/16）。13名护士协调员进行诊断披露护士咨询；7名进行患者首次接触咨询；6名进行门诊护士咨询，各中心之间存在很大差异。护士协调员的存在与完整诊断披露过程的完成相关（p = 0.045）。
在法国，HCC患者路径管理的护士协调员主要存在于每年病例量超过75例患者的大学肝病科。所有护士协调员都提供患者信息和咨询，但他们在护理协调、患者支持和整体评估方面的作用各不相同且未标准化。
