复杂皮肤癌治疗需要重建整形手术:对患者经历和需求的访谈研究。

Complex skin cancer treatment requiring reconstructive plastic surgery: an interview study on the experiences and needs of patients.

机构信息

Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.

出版信息

Arch Dermatol Res. 2022 Jan;314(1):25-36. doi: 10.1007/s00403-021-02204-3. Epub 2021 Feb 21.

Abstract

To provide patient-centered care, it is essential to explore what patients consider important and to adjust care accordingly. This may specifically be relevant for patients with complex skin cancer, for whom the care process is often more complicated and psychological and social problems may play a larger role. The objective was to explore the experiences and needs of patients who had undergone surgical treatment by a dermatologist for a complex skin cancer with a subsequent reconstruction by a plastic surgeon. An interview study was conducted among 16 patients who had undergone surgical treatment by a dermatologist and reconstruction by a plastic surgeon for basal cell carcinoma, cutaneous squamous cell carcinoma, or lentigo maligna. The interviews focused on patients' experiences and needs regarding care using a predefined topic list. All interviews were audio-taped, transcribed verbatim and inductively analyzed using Atlas.ti. Patients reported a need for a skilled and friendly physician who tailors information and communication to their individual situation. A need for continuity of care and improved collaboration between healthcare providers was also emphasized. Furthermore, patients experienced complications and unmet expectations and expressed a need for shared decision-making at various steps throughout the treatment process (depending on age). Patients also considered completeness of tumor removal, follow-up visits with multiple specialists to be planned the same day and recognition of the psychological impact of the disease on the partner important. To improve patient-centered care for complex skin cancer patients, more efforts should be directed towards improving continuity of care and collaboration. Furthermore, it is advocated for physicians to be sensitive to the individual needs of patients and their partner and adjust information, communication and (supportive) care accordingly.

摘要

为了提供以患者为中心的护理,探索患者认为重要的内容并相应地调整护理至关重要。对于患有复杂皮肤癌的患者,这可能尤其相关,因为他们的护理过程通常更为复杂,心理和社会问题可能会发挥更大的作用。目的是探讨接受皮肤科医生治疗复杂皮肤癌并随后由整形外科医生进行重建的患者的经验和需求。对 16 名接受皮肤科医生手术和整形外科医生重建的患者进行了访谈研究,这些患者患有基底细胞癌、皮肤鳞状细胞癌或恶性黑色素瘤。访谈重点关注患者对护理的经验和需求,使用预定义的主题列表。所有访谈均进行录音、逐字转录,并使用 Atlas.ti 进行归纳分析。患者报告说需要一位技术熟练且友好的医生,根据他们的个人情况量身定制信息和沟通。患者还强调需要连续性护理,并改善医疗保健提供者之间的协作。此外,患者还经历了并发症和未满足的期望,并表示需要在治疗过程的各个阶段(取决于年龄)进行共同决策。患者还认为肿瘤切除的完整性、计划同一天进行多位专家的随访以及认识到疾病对伴侣的心理影响很重要。为了改善复杂皮肤癌患者的以患者为中心的护理,应更加努力改善连续性护理和协作。此外,提倡医生要对患者及其伴侣的个体需求敏感,并相应地调整信息、沟通和(支持)护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/718e/8741685/ae45fc255924/403_2021_2204_Fig1_HTML.jpg

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